|
HC CT SI JTS W CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$421.84 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$534.51
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SI JTS W CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$172.92
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$172.92
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.92
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$172.92
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$172.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$172.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Railroad Medicare Medicare |
$172.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.92
|
| Rate for Payer: UHC Medicare Advantage |
$178.10
|
| Rate for Payer: VA VA |
$172.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SI JTS WO CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$421.84 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$534.51
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SI JTS WO CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$172.92
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$172.92
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.92
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$172.92
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$172.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$172.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Railroad Medicare Medicare |
$172.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.92
|
| Rate for Payer: UHC Medicare Advantage |
$178.10
|
| Rate for Payer: VA VA |
$172.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$172.92
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: BCN Medicare Advantage |
$172.92
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.92
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$172.92
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$172.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$172.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: Railroad Medicare Medicare |
$172.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.92
|
| Rate for Payer: UHC Medicare Advantage |
$178.10
|
| Rate for Payer: VA VA |
$172.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$421.84 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: BCBS Trust/PPO |
$534.51
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.66
|
| Rate for Payer: UHC Core |
$577.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
OP
|
$1,602.22
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,442.00 |
| Rate for Payer: Aetna Commercial |
$1,361.89
|
| Rate for Payer: Aetna Medicare |
$416.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$500.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$500.69
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$400.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.73
|
| Rate for Payer: BCN Commercial |
$1,245.73
|
| Rate for Payer: BCN Medicare Advantage |
$400.56
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cofinity Commercial |
$1,377.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.56
|
| Rate for Payer: Healthscope Commercial |
$1,442.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.66
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$420.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$460.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,361.89
|
| Rate for Payer: PACE Senior Care Partners |
$380.53
|
| Rate for Payer: PACE SWMI |
$400.56
|
| Rate for Payer: PHP Commercial |
$1,361.89
|
| Rate for Payer: PHP Medicare Advantage |
$400.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,393.93
|
| Rate for Payer: Priority Health Medicare |
$400.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.19
|
| Rate for Payer: Railroad Medicare Medicare |
$400.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.95
|
| Rate for Payer: UHC Core |
$1,337.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.56
|
| Rate for Payer: UHC Medicare Advantage |
$412.57
|
| Rate for Payer: VA VA |
$400.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.66
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
IP
|
$1,602.22
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$977.19 |
| Max. Negotiated Rate |
$1,442.00 |
| Rate for Payer: Aetna Commercial |
$1,361.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.20
|
| Rate for Payer: BCN Commercial |
$1,238.20
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cofinity Commercial |
$1,377.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.78
|
| Rate for Payer: Healthscope Commercial |
$1,442.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,361.89
|
| Rate for Payer: PHP Commercial |
$1,361.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,393.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.95
|
| Rate for Payer: UHC Core |
$1,337.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.66
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
OP
|
$1,356.10
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: Aetna Medicare |
$352.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$423.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$423.78
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$339.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.37
|
| Rate for Payer: BCN Commercial |
$1,054.37
|
| Rate for Payer: BCN Medicare Advantage |
$339.02
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.02
|
| Rate for Payer: Healthscope Commercial |
$1,220.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.08
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,152.68
|
| Rate for Payer: PACE Senior Care Partners |
$322.07
|
| Rate for Payer: PACE SWMI |
$339.02
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: PHP Medicare Advantage |
$339.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,179.81
|
| Rate for Payer: Priority Health Medicare |
$339.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.09
|
| Rate for Payer: Railroad Medicare Medicare |
$339.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.37
|
| Rate for Payer: UHC Core |
$1,132.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.02
|
| Rate for Payer: UHC Medicare Advantage |
$349.20
|
| Rate for Payer: VA VA |
$339.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.08
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
IP
|
$1,356.10
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$827.09 |
| Max. Negotiated Rate |
$1,220.49 |
| Rate for Payer: Aetna Commercial |
$1,152.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,047.99
|
| Rate for Payer: BCN Commercial |
$1,047.99
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,166.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$1,220.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,152.68
|
| Rate for Payer: PHP Commercial |
$1,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,179.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.37
|
| Rate for Payer: UHC Core |
$1,132.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.08
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
IP
|
$1,844.57
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$1,660.11 |
| Rate for Payer: Aetna Commercial |
$1,567.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,425.48
|
| Rate for Payer: BCN Commercial |
$1,425.48
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cofinity Commercial |
$1,586.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.66
|
| Rate for Payer: Healthscope Commercial |
$1,660.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,383.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,567.88
|
| Rate for Payer: PHP Commercial |
$1,567.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,604.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,125.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,623.22
|
| Rate for Payer: UHC Core |
$1,540.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,383.43
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
OP
|
$1,844.57
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,660.11 |
| Rate for Payer: Aetna Commercial |
$1,567.88
|
| Rate for Payer: Aetna Medicare |
$479.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$576.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$576.43
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$461.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.15
|
| Rate for Payer: BCN Commercial |
$1,434.15
|
| Rate for Payer: BCN Medicare Advantage |
$461.14
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cofinity Commercial |
$1,586.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$461.14
|
| Rate for Payer: Healthscope Commercial |
$1,660.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,383.43
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$484.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$530.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,567.88
|
| Rate for Payer: PACE Senior Care Partners |
$438.09
|
| Rate for Payer: PACE SWMI |
$461.14
|
| Rate for Payer: PHP Commercial |
$1,567.88
|
| Rate for Payer: PHP Medicare Advantage |
$461.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,604.78
|
| Rate for Payer: Priority Health Medicare |
$461.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,125.00
|
| Rate for Payer: Railroad Medicare Medicare |
$461.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,623.22
|
| Rate for Payer: UHC Core |
$1,540.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$461.14
|
| Rate for Payer: UHC Medicare Advantage |
$474.98
|
| Rate for Payer: VA VA |
$461.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,383.43
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
OP
|
$1,900.60
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,710.54 |
| Rate for Payer: Aetna Commercial |
$1,615.51
|
| Rate for Payer: Aetna Medicare |
$494.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.94
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$475.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.72
|
| Rate for Payer: BCN Commercial |
$1,477.72
|
| Rate for Payer: BCN Medicare Advantage |
$475.15
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cofinity Commercial |
$1,634.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.15
|
| Rate for Payer: Healthscope Commercial |
$1,710.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.45
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$498.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,615.51
|
| Rate for Payer: PACE Senior Care Partners |
$451.39
|
| Rate for Payer: PACE SWMI |
$475.15
|
| Rate for Payer: PHP Commercial |
$1,615.51
|
| Rate for Payer: PHP Medicare Advantage |
$475.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,653.52
|
| Rate for Payer: Priority Health Medicare |
$475.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.18
|
| Rate for Payer: Railroad Medicare Medicare |
$475.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.53
|
| Rate for Payer: UHC Core |
$1,587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.15
|
| Rate for Payer: UHC Medicare Advantage |
$489.40
|
| Rate for Payer: VA VA |
$475.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.45
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
IP
|
$1,900.60
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,159.18 |
| Max. Negotiated Rate |
$1,710.54 |
| Rate for Payer: Aetna Commercial |
$1,615.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.78
|
| Rate for Payer: BCN Commercial |
$1,468.78
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cofinity Commercial |
$1,634.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.48
|
| Rate for Payer: Healthscope Commercial |
$1,710.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,615.51
|
| Rate for Payer: PHP Commercial |
$1,615.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,653.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.53
|
| Rate for Payer: UHC Core |
$1,587.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.45
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$967.42 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.82
|
| Rate for Payer: BCN Commercial |
$1,225.82
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,379.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,395.86
|
| Rate for Payer: UHC Core |
$1,324.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.65
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna Medicare |
$412.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$495.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$495.69
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$396.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.27
|
| Rate for Payer: BCN Commercial |
$1,233.27
|
| Rate for Payer: BCN Medicare Advantage |
$396.55
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.55
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.65
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$416.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PACE Senior Care Partners |
$376.72
|
| Rate for Payer: PACE SWMI |
$396.55
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: PHP Medicare Advantage |
$396.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,379.99
|
| Rate for Payer: Priority Health Medicare |
$396.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.42
|
| Rate for Payer: Railroad Medicare Medicare |
$396.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,395.86
|
| Rate for Payer: UHC Core |
$1,324.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.55
|
| Rate for Payer: UHC Medicare Advantage |
$408.45
|
| Rate for Payer: VA VA |
$396.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.65
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna Medicare |
$561.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$674.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$674.97
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$539.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.32
|
| Rate for Payer: BCN Commercial |
$1,679.32
|
| Rate for Payer: BCN Medicare Advantage |
$539.98
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.98
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,619.92
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$566.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PACE Senior Care Partners |
$512.98
|
| Rate for Payer: PACE SWMI |
$539.98
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: PHP Medicare Advantage |
$539.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.11
|
| Rate for Payer: Priority Health Medicare |
$539.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,317.32
|
| Rate for Payer: Railroad Medicare Medicare |
$539.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.71
|
| Rate for Payer: UHC Core |
$1,803.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.98
|
| Rate for Payer: UHC Medicare Advantage |
$556.17
|
| Rate for Payer: VA VA |
$539.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,619.92
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.17
|
| Rate for Payer: BCN Commercial |
$1,669.17
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,619.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,317.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.71
|
| Rate for Payer: UHC Core |
$1,803.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,619.92
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: Aetna Medicare |
$504.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$605.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$605.82
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$484.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.27
|
| Rate for Payer: BCN Commercial |
$1,507.27
|
| Rate for Payer: BCN Medicare Advantage |
$484.65
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.65
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.96
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$508.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PACE Senior Care Partners |
$460.42
|
| Rate for Payer: PACE SWMI |
$484.65
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: PHP Medicare Advantage |
$484.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.59
|
| Rate for Payer: Priority Health Medicare |
$484.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.36
|
| Rate for Payer: Railroad Medicare Medicare |
$484.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.98
|
| Rate for Payer: UHC Core |
$1,618.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.65
|
| Rate for Payer: UHC Medicare Advantage |
$499.19
|
| Rate for Payer: VA VA |
$484.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.96
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,182.36 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.16
|
| Rate for Payer: BCN Commercial |
$1,498.16
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.98
|
| Rate for Payer: UHC Core |
$1,618.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.96
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna Medicare |
$412.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$495.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$495.69
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$396.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.27
|
| Rate for Payer: BCN Commercial |
$1,233.27
|
| Rate for Payer: BCN Medicare Advantage |
$396.55
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.55
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.65
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$416.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PACE Senior Care Partners |
$376.72
|
| Rate for Payer: PACE SWMI |
$396.55
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: PHP Medicare Advantage |
$396.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,379.99
|
| Rate for Payer: Priority Health Medicare |
$396.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.42
|
| Rate for Payer: Railroad Medicare Medicare |
$396.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,395.86
|
| Rate for Payer: UHC Core |
$1,324.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.55
|
| Rate for Payer: UHC Medicare Advantage |
$408.45
|
| Rate for Payer: VA VA |
$396.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.65
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$967.42 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.82
|
| Rate for Payer: BCN Commercial |
$1,225.82
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,379.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,395.86
|
| Rate for Payer: UHC Core |
$1,324.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.65
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna Medicare |
$561.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$674.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$674.97
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$539.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.32
|
| Rate for Payer: BCN Commercial |
$1,679.32
|
| Rate for Payer: BCN Medicare Advantage |
$539.98
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.98
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,619.92
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$566.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PACE Senior Care Partners |
$512.98
|
| Rate for Payer: PACE SWMI |
$539.98
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: PHP Medicare Advantage |
$539.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.11
|
| Rate for Payer: Priority Health Medicare |
$539.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,317.32
|
| Rate for Payer: Railroad Medicare Medicare |
$539.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.71
|
| Rate for Payer: UHC Core |
$1,803.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.98
|
| Rate for Payer: UHC Medicare Advantage |
$556.17
|
| Rate for Payer: VA VA |
$539.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,619.92
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.17
|
| Rate for Payer: BCN Commercial |
$1,669.17
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,619.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,317.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.71
|
| Rate for Payer: UHC Core |
$1,803.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,619.92
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,182.36 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.16
|
| Rate for Payer: BCN Commercial |
$1,498.16
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,453.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.98
|
| Rate for Payer: UHC Core |
$1,618.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,453.96
|
|
