|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,291.11 |
| Max. Negotiated Rate |
$1,844.44 |
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.15
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$1,434.57
|
| Rate for Payer: Cofinity Commercial |
$2,151.85
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,151.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.96
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
| Rate for Payer: Priority Health SBD |
$1,936.66
|
| Rate for Payer: Priority Health SBD |
$1,291.11
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,329.58 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$250.83
|
| Rate for Payer: BCN Commercial |
$250.83
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,561.73
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$633.41 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.52
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$703.79
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$703.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health SBD |
$633.41
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: Aetna Medicare |
$502.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.52
|
| Rate for Payer: BCBS Complete |
$402.16
|
| Rate for Payer: BCBS Trust/PPO |
$670.74
|
| Rate for Payer: BCN Commercial |
$670.74
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$703.79
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$703.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health SBD |
$633.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.26
|
| Rate for Payer: UHC Exchange |
$744.00
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$335.06
|
| Rate for Payer: BCN Commercial |
$335.06
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Cofinity Commercial |
$1,551.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,551.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,396.69
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,640.56
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,396.69 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.03
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,551.88
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,551.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health SBD |
$1,396.69
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$377.80
|
| Rate for Payer: BCN Commercial |
$377.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Cofinity Commercial |
$1,502.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,502.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,352.29
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,588.40
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,352.29 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.22
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,502.54
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,502.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health SBD |
$1,352.29
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$319.97
|
| Rate for Payer: BCN Commercial |
$319.97
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Commercial |
$1,424.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,505.99
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,282.13 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,424.58
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,756.91 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,812.68
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$1,952.12
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,952.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health SBD |
$1,756.91
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,812.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$467.69
|
| Rate for Payer: BCN Commercial |
$467.69
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Cofinity Commercial |
$1,952.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,952.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,756.91
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$2,063.67
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,413.20 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.07
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,570.23
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,570.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health SBD |
$1,413.20
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$368.37
|
| Rate for Payer: BCN Commercial |
$368.37
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Cofinity Commercial |
$1,570.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,570.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,413.20
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,659.95
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$314.94
|
| Rate for Payer: BCN Commercial |
$314.94
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Cofinity Commercial |
$1,422.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,280.63
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,504.23
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,280.63 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.28
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,422.92
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health SBD |
$1,280.63
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,920.97 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,981.95
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,134.41
|
| Rate for Payer: Cofinity Commercial |
$2,622.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,134.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health SBD |
$1,920.97
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,981.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$459.53
|
| Rate for Payer: BCN Commercial |
$459.53
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,622.28
|
| Rate for Payer: Cofinity Commercial |
$2,134.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,134.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,920.97
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$2,256.38
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,197.10 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,235.10
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,330.11
|
| Rate for Payer: Cofinity Commercial |
$1,634.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,330.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health SBD |
$1,197.10
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,235.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$603.89
|
| Rate for Payer: BCN Commercial |
$603.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,634.14
|
| Rate for Payer: Cofinity Commercial |
$1,330.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,330.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$1,197.10
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$1,406.12
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$48.57
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$375.91
|
| Rate for Payer: BCN Commercial |
$375.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$1,997.21
|
| Rate for Payer: Cofinity Commercial |
$1,625.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,625.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,463.07
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,718.53
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,463.07 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.52
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$1,625.64
|
| Rate for Payer: Cofinity Commercial |
$1,997.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,625.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health SBD |
$1,463.07
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
IP
|
$1,160.76
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$731.28 |
| Max. Negotiated Rate |
$1,044.68 |
| Rate for Payer: Aetna Commercial |
$986.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.49
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$812.53
|
| Rate for Payer: Cofinity Commercial |
$998.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$812.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Healthscope Commercial |
$1,044.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: PHP Commercial |
$986.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: Priority Health SBD |
$731.28
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
OP
|
$1,160.76
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna Commercial |
$986.65
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$375.91
|
| Rate for Payer: BCN Commercial |
$375.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$998.25
|
| Rate for Payer: Cofinity Commercial |
$812.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$812.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,044.68
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$986.65
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$731.28
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$858.96
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
