|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,189.42
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,970.48 |
| Rate for Payer: Aetna Commercial |
$1,861.01
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$442.93
|
| Rate for Payer: BCN Commercial |
$442.93
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cofinity Advantage |
$1,532.59
|
| Rate for Payer: Cofinity Commercial |
$1,882.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,970.48
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.01
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.07
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,861.01
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,379.33
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.12
|
| Rate for Payer: UHC Core |
$1,140.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$860.44
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,307.77 |
| Max. Negotiated Rate |
$1,868.24 |
| Rate for Payer: Aetna Commercial |
$1,764.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.28
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Advantage |
$1,453.07
|
| Rate for Payer: Cofinity Commercial |
$1,785.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Healthscope Commercial |
$1,868.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: PHP Commercial |
$1,764.45
|
| Rate for Payer: Priority Health SBD |
$1,307.77
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,868.24 |
| Rate for Payer: Aetna Commercial |
$1,764.45
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$377.05
|
| Rate for Payer: BCN Commercial |
$377.05
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Advantage |
$1,453.07
|
| Rate for Payer: Cofinity Commercial |
$1,785.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,868.24
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,764.45
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,307.77
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.28
|
| Rate for Payer: UHC Core |
$1,081.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$815.80
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,792.04 |
| Max. Negotiated Rate |
$2,560.06 |
| Rate for Payer: Aetna Commercial |
$2,417.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,848.93
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Advantage |
$1,991.16
|
| Rate for Payer: Cofinity Commercial |
$2,446.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Healthscope Commercial |
$2,560.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: PHP Commercial |
$2,417.83
|
| Rate for Payer: Priority Health SBD |
$1,792.04
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,560.06 |
| Rate for Payer: Aetna Commercial |
$2,417.83
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,848.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$550.44
|
| Rate for Payer: BCN Commercial |
$550.44
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Advantage |
$1,991.16
|
| Rate for Payer: Cofinity Commercial |
$2,446.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,560.06
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,417.83
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,792.04
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,848.93
|
| Rate for Payer: UHC Core |
$1,481.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,117.89
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,441.47 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.23
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Advantage |
$1,601.63
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: Priority Health SBD |
$1,441.47
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$434.60
|
| Rate for Payer: BCN Commercial |
$434.60
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Advantage |
$1,601.63
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,441.47
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.23
|
| Rate for Payer: UHC Core |
$1,192.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$899.20
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,866.05 |
| Rate for Payer: Aetna Commercial |
$1,762.38
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$369.49
|
| Rate for Payer: BCN Commercial |
$369.49
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Advantage |
$1,451.37
|
| Rate for Payer: Cofinity Commercial |
$1,783.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,866.05
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,762.38
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,306.24
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.70
|
| Rate for Payer: UHC Core |
$1,080.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$814.84
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,306.24 |
| Max. Negotiated Rate |
$1,866.05 |
| Rate for Payer: Aetna Commercial |
$1,762.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.70
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Advantage |
$1,451.37
|
| Rate for Payer: Cofinity Commercial |
$1,783.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Healthscope Commercial |
$1,866.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: PHP Commercial |
$1,762.38
|
| Rate for Payer: Priority Health SBD |
$1,306.24
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,959.39 |
| Max. Negotiated Rate |
$2,799.13 |
| Rate for Payer: Aetna Commercial |
$2,643.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.59
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Advantage |
$2,177.10
|
| Rate for Payer: Cofinity Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Healthscope Commercial |
$2,799.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: PHP Commercial |
$2,643.62
|
| Rate for Payer: Priority Health SBD |
$1,959.39
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,799.13 |
| Rate for Payer: Aetna Commercial |
$2,643.62
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$539.84
|
| Rate for Payer: BCN Commercial |
$539.84
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Advantage |
$2,177.10
|
| Rate for Payer: Cofinity Commercial |
$2,674.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,799.13
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,643.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,959.39
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,021.59
|
| Rate for Payer: UHC Core |
$1,620.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,222.29
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$224.40
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Advantage |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$224.40
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$166.32
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.60
|
| Rate for Payer: UHC Core |
$137.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$103.75
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$224.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Advantage |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PHP Commercial |
$224.40
|
| Rate for Payer: Priority Health SBD |
$166.32
|
|
|
HC MR SAFETY IMPLANT ELECTRONICS PREP
|
Facility
|
IP
|
$199.92
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
61000095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$179.93 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Advantage |
$139.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.94
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: Priority Health SBD |
$125.95
|
|
|
HC MR SAFETY IMPLANT ELECTRONICS PREP
|
Facility
|
OP
|
$199.92
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
61000095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$306.34 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: Aetna Medicare |
$98.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Advantage |
$139.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Mclaren Medicaid |
$49.54
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$284.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.94
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.34
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health SBD |
$125.95
|
| Rate for Payer: Priority Health Tiered Network |
$245.07
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.95
|
| Rate for Payer: UHC Core |
$104.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$78.57
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health SBD |
$34.06
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$15.07
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.14
|
| Rate for Payer: UHC Core |
$28.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$21.25
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$172.62 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Advantage |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: Priority Health SBD |
$172.62
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$107.68 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Advantage |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: Priority Health SBD |
$172.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.10
|
| Rate for Payer: UHC Core |
$142.75
|
| Rate for Payer: UHC Exchange |
$107.68
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$1,744.34 |
| Rate for Payer: Aetna Commercial |
$1,647.44
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$727.35
|
| Rate for Payer: BCN Commercial |
$727.35
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Advantage |
$1,356.71
|
| Rate for Payer: Cofinity Commercial |
$1,666.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$1,744.34
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.44
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$1,647.44
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$1,221.04
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,259.80
|
| Rate for Payer: UHC Core |
$1,009.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$761.70
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,221.04 |
| Max. Negotiated Rate |
$1,744.34 |
| Rate for Payer: Aetna Commercial |
$1,647.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.80
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Advantage |
$1,356.71
|
| Rate for Payer: Cofinity Commercial |
$1,666.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Healthscope Commercial |
$1,744.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| Rate for Payer: PHP Commercial |
$1,647.44
|
| Rate for Payer: Priority Health SBD |
$1,221.04
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,131.91 |
| Rate for Payer: Aetna Commercial |
$2,013.47
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,539.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$442.17
|
| Rate for Payer: BCN Commercial |
$442.17
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Advantage |
$1,658.15
|
| Rate for Payer: Cofinity Commercial |
$2,037.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,131.91
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.47
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,013.47
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,492.34
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,539.71
|
| Rate for Payer: UHC Core |
$1,234.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$930.93
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,492.34 |
| Max. Negotiated Rate |
$2,131.91 |
| Rate for Payer: Aetna Commercial |
$2,013.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,539.71
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Advantage |
$1,658.15
|
| Rate for Payer: Cofinity Commercial |
$2,037.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Healthscope Commercial |
$2,131.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| Rate for Payer: PHP Commercial |
$2,013.47
|
| Rate for Payer: Priority Health SBD |
$1,492.34
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
OP
|
$1,183.98
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,124.16 |
| Rate for Payer: Aetna Commercial |
$1,006.38
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$442.17
|
| Rate for Payer: BCN Commercial |
$442.17
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cofinity Advantage |
$828.79
|
| Rate for Payer: Cofinity Commercial |
$1,018.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,065.58
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.38
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.99
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,006.38
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$745.91
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.59
|
| Rate for Payer: UHC Core |
$616.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$465.30
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
IP
|
$1,183.98
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$745.91 |
| Max. Negotiated Rate |
$1,065.58 |
| Rate for Payer: Aetna Commercial |
$1,006.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.59
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cofinity Advantage |
$828.79
|
| Rate for Payer: Cofinity Commercial |
$1,018.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.18
|
| Rate for Payer: Healthscope Commercial |
$1,065.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.99
|
| Rate for Payer: PHP Commercial |
$1,006.38
|
| Rate for Payer: Priority Health SBD |
$745.91
|
|
