|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.71
|
| Rate for Payer: BCN Commercial |
$1,250.33
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,407.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.77
|
| Rate for Payer: UHC Core |
$1,350.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.44
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna Medicare |
$572.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.47
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$550.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,811.17
|
| Rate for Payer: BCN Commercial |
$1,712.91
|
| Rate for Payer: BCN Medicare Advantage |
$550.78
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.78
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.31
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Senior Care Partners |
$523.24
|
| Rate for Payer: PACE SWMI |
$550.78
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: PHP Medicare Advantage |
$550.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Medicare |
$556.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: Railroad Medicare Medicare |
$550.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.78
|
| Rate for Payer: UHC Exchange |
$550.78
|
| Rate for Payer: UHC Medicare Advantage |
$550.78
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$550.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.39
|
| Rate for Payer: BCN Commercial |
$1,702.56
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna Medicare |
$514.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$617.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$617.93
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$494.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,625.60
|
| Rate for Payer: BCN Commercial |
$1,537.41
|
| Rate for Payer: BCN Medicare Advantage |
$494.34
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.34
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.04
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.06
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PACE Senior Care Partners |
$469.63
|
| Rate for Payer: PACE SWMI |
$494.34
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: PHP Medicare Advantage |
$494.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.32
|
| Rate for Payer: Priority Health Medicare |
$499.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.84
|
| Rate for Payer: Railroad Medicare Medicare |
$494.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.09
|
| Rate for Payer: UHC Core |
$1,651.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.34
|
| Rate for Payer: UHC Exchange |
$494.34
|
| Rate for Payer: UHC Medicare Advantage |
$494.34
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$494.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.04
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,285.30 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.14
|
| Rate for Payer: BCN Commercial |
$1,528.12
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.09
|
| Rate for Payer: UHC Core |
$1,651.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.04
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.71
|
| Rate for Payer: BCN Commercial |
$1,250.33
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,407.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.77
|
| Rate for Payer: UHC Core |
$1,350.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.44
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna Medicare |
$420.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$505.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$505.60
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$404.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,330.09
|
| Rate for Payer: BCN Commercial |
$1,257.93
|
| Rate for Payer: BCN Medicare Advantage |
$404.48
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.48
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.44
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.70
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PACE Senior Care Partners |
$384.26
|
| Rate for Payer: PACE SWMI |
$404.48
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: PHP Medicare Advantage |
$404.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,407.59
|
| Rate for Payer: Priority Health Medicare |
$408.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.01
|
| Rate for Payer: Railroad Medicare Medicare |
$404.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.77
|
| Rate for Payer: UHC Core |
$1,350.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.48
|
| Rate for Payer: UHC Exchange |
$404.48
|
| Rate for Payer: UHC Medicare Advantage |
$404.48
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$404.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.44
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna Medicare |
$572.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.47
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$550.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,811.17
|
| Rate for Payer: BCN Commercial |
$1,712.91
|
| Rate for Payer: BCN Medicare Advantage |
$550.78
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.78
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.31
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Senior Care Partners |
$523.24
|
| Rate for Payer: PACE SWMI |
$550.78
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: PHP Medicare Advantage |
$550.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Medicare |
$556.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: Railroad Medicare Medicare |
$550.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.78
|
| Rate for Payer: UHC Exchange |
$550.78
|
| Rate for Payer: UHC Medicare Advantage |
$550.78
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$550.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.39
|
| Rate for Payer: BCN Commercial |
$1,702.56
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna Medicare |
$514.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$617.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$617.93
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$494.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,625.60
|
| Rate for Payer: BCN Commercial |
$1,537.41
|
| Rate for Payer: BCN Medicare Advantage |
$494.34
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.34
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.04
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.06
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PACE Senior Care Partners |
$469.63
|
| Rate for Payer: PACE SWMI |
$494.34
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: PHP Medicare Advantage |
$494.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.32
|
| Rate for Payer: Priority Health Medicare |
$499.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.84
|
| Rate for Payer: Railroad Medicare Medicare |
$494.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.09
|
| Rate for Payer: UHC Core |
$1,651.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.34
|
| Rate for Payer: UHC Exchange |
$494.34
|
| Rate for Payer: UHC Medicare Advantage |
$494.34
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$494.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.04
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,285.30 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.14
|
| Rate for Payer: BCN Commercial |
$1,528.12
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.09
|
| Rate for Payer: UHC Core |
$1,651.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.04
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna Medicare |
$420.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$505.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$505.60
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$404.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,330.09
|
| Rate for Payer: BCN Commercial |
$1,257.93
|
| Rate for Payer: BCN Medicare Advantage |
$404.48
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.48
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.44
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.70
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PACE Senior Care Partners |
$384.26
|
| Rate for Payer: PACE SWMI |
$404.48
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: PHP Medicare Advantage |
$404.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,407.59
|
| Rate for Payer: Priority Health Medicare |
$408.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.01
|
| Rate for Payer: Railroad Medicare Medicare |
$404.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.77
|
| Rate for Payer: UHC Core |
$1,350.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.48
|
| Rate for Payer: UHC Exchange |
$404.48
|
| Rate for Payer: UHC Medicare Advantage |
$404.48
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$404.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.44
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.71
|
| Rate for Payer: BCN Commercial |
$1,250.33
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,407.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.77
|
| Rate for Payer: UHC Core |
$1,350.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.44
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna Medicare |
$572.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.47
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$550.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,811.17
|
| Rate for Payer: BCN Commercial |
$1,712.91
|
| Rate for Payer: BCN Medicare Advantage |
$550.78
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.78
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.31
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Senior Care Partners |
$523.24
|
| Rate for Payer: PACE SWMI |
$550.78
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: PHP Medicare Advantage |
$550.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Medicare |
$556.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: Railroad Medicare Medicare |
$550.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.78
|
| Rate for Payer: UHC Exchange |
$550.78
|
| Rate for Payer: UHC Medicare Advantage |
$550.78
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$550.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.39
|
| Rate for Payer: BCN Commercial |
$1,702.56
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,916.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.73
|
| Rate for Payer: UHC Core |
$1,839.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,652.32
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,192.93 |
| Max. Negotiated Rate |
$1,651.74 |
| Rate for Payer: Aetna Commercial |
$1,559.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.13
|
| Rate for Payer: BCN Commercial |
$1,418.30
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,578.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Healthscope Commercial |
$1,651.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,376.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.98
|
| Rate for Payer: Nomi Health Commercial |
$1,504.92
|
| Rate for Payer: PHP Commercial |
$1,559.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,596.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,615.04
|
| Rate for Payer: UHC Core |
$1,532.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,376.45
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,651.74 |
| Rate for Payer: Aetna Commercial |
$1,559.98
|
| Rate for Payer: Aetna Medicare |
$477.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$573.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$573.52
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$458.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,508.78
|
| Rate for Payer: BCN Commercial |
$1,426.92
|
| Rate for Payer: BCN Medicare Advantage |
$458.82
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,578.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.82
|
| Rate for Payer: Healthscope Commercial |
$1,651.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,376.45
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.76
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$527.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.98
|
| Rate for Payer: Nomi Health Commercial |
$1,504.92
|
| Rate for Payer: PACE Senior Care Partners |
$435.88
|
| Rate for Payer: PACE SWMI |
$458.82
|
| Rate for Payer: PHP Commercial |
$1,559.98
|
| Rate for Payer: PHP Medicare Advantage |
$458.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,596.68
|
| Rate for Payer: Priority Health Medicare |
$463.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.63
|
| Rate for Payer: Railroad Medicare Medicare |
$458.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,615.04
|
| Rate for Payer: UHC Core |
$1,532.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.82
|
| Rate for Payer: UHC Exchange |
$458.82
|
| Rate for Payer: UHC Medicare Advantage |
$458.82
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$458.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,376.45
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
OP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,305.29 |
| Rate for Payer: Aetna Commercial |
$1,232.77
|
| Rate for Payer: Aetna Medicare |
$377.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$453.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$453.22
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$362.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,192.31
|
| Rate for Payer: BCN Commercial |
$1,127.62
|
| Rate for Payer: BCN Medicare Advantage |
$362.58
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,247.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.58
|
| Rate for Payer: Healthscope Commercial |
$1,305.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.74
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.71
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,189.26
|
| Rate for Payer: PACE Senior Care Partners |
$344.45
|
| Rate for Payer: PACE SWMI |
$362.58
|
| Rate for Payer: PHP Commercial |
$1,232.77
|
| Rate for Payer: PHP Medicare Advantage |
$362.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,261.78
|
| Rate for Payer: Priority Health Medicare |
$366.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.71
|
| Rate for Payer: Railroad Medicare Medicare |
$362.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.28
|
| Rate for Payer: UHC Core |
$1,211.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.58
|
| Rate for Payer: UHC Exchange |
$362.58
|
| Rate for Payer: UHC Medicare Advantage |
$362.58
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$362.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.74
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
IP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.71 |
| Max. Negotiated Rate |
$1,305.29 |
| Rate for Payer: Aetna Commercial |
$1,232.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.90
|
| Rate for Payer: BCN Commercial |
$1,120.81
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,247.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Healthscope Commercial |
$1,305.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,189.26
|
| Rate for Payer: PHP Commercial |
$1,232.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,261.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.28
|
| Rate for Payer: UHC Core |
$1,211.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.74
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
OP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,093.67 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: Aetna Medicare |
$315.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.75
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$303.80
|
| Rate for Payer: BCBS Trust/PPO |
$999.01
|
| Rate for Payer: BCN Commercial |
$944.81
|
| Rate for Payer: BCN Medicare Advantage |
$303.80
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$1,045.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.80
|
| Rate for Payer: Healthscope Commercial |
$1,093.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$911.39
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.99
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.91
|
| Rate for Payer: Nomi Health Commercial |
$996.46
|
| Rate for Payer: PACE Senior Care Partners |
$288.61
|
| Rate for Payer: PACE SWMI |
$303.80
|
| Rate for Payer: PHP Commercial |
$1,032.91
|
| Rate for Payer: PHP Medicare Advantage |
$303.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,057.22
|
| Rate for Payer: Priority Health Medicare |
$306.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$814.18
|
| Rate for Payer: Railroad Medicare Medicare |
$303.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.37
|
| Rate for Payer: UHC Core |
$1,014.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.80
|
| Rate for Payer: UHC Exchange |
$303.80
|
| Rate for Payer: UHC Medicare Advantage |
$303.80
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$303.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$911.39
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
IP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$789.87 |
| Max. Negotiated Rate |
$1,093.67 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: BCBS Trust/PPO |
$991.96
|
| Rate for Payer: BCN Commercial |
$939.10
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$1,045.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Healthscope Commercial |
$1,093.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$911.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.91
|
| Rate for Payer: Nomi Health Commercial |
$996.46
|
| Rate for Payer: PHP Commercial |
$1,032.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,057.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$814.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.37
|
| Rate for Payer: UHC Core |
$1,014.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$911.39
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,099.05 |
| Max. Negotiated Rate |
$1,521.76 |
| Rate for Payer: Aetna Commercial |
$1,437.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.24
|
| Rate for Payer: BCN Commercial |
$1,306.69
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,454.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Healthscope Commercial |
$1,521.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.22
|
| Rate for Payer: Nomi Health Commercial |
$1,386.50
|
| Rate for Payer: PHP Commercial |
$1,437.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,471.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.95
|
| Rate for Payer: UHC Core |
$1,411.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.14
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,521.76 |
| Rate for Payer: Aetna Commercial |
$1,437.22
|
| Rate for Payer: Aetna Medicare |
$439.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$528.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$528.39
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$422.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,390.05
|
| Rate for Payer: BCN Commercial |
$1,314.64
|
| Rate for Payer: BCN Medicare Advantage |
$422.71
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,454.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.71
|
| Rate for Payer: Healthscope Commercial |
$1,521.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.14
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.85
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.22
|
| Rate for Payer: Nomi Health Commercial |
$1,386.50
|
| Rate for Payer: PACE Senior Care Partners |
$401.58
|
| Rate for Payer: PACE SWMI |
$422.71
|
| Rate for Payer: PHP Commercial |
$1,437.22
|
| Rate for Payer: PHP Medicare Advantage |
$422.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,471.04
|
| Rate for Payer: Priority Health Medicare |
$426.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,132.87
|
| Rate for Payer: Railroad Medicare Medicare |
$422.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.95
|
| Rate for Payer: UHC Core |
$1,411.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.71
|
| Rate for Payer: UHC Exchange |
$422.71
|
| Rate for Payer: UHC Medicare Advantage |
$422.71
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$422.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.14
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
IP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$659.09 |
| Max. Negotiated Rate |
$912.58 |
| Rate for Payer: Aetna Commercial |
$861.88
|
| Rate for Payer: BCBS Trust/PPO |
$827.71
|
| Rate for Payer: BCN Commercial |
$783.60
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$872.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Healthscope Commercial |
$912.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$760.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.88
|
| Rate for Payer: Nomi Health Commercial |
$831.46
|
| Rate for Payer: PHP Commercial |
$861.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.09
|
| Rate for Payer: Priority Health HMO/PPO |
$882.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$679.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$892.30
|
| Rate for Payer: UHC Core |
$846.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$760.48
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
OP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$912.58 |
| Rate for Payer: Aetna Commercial |
$861.88
|
| Rate for Payer: Aetna Medicare |
$263.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.87
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$253.50
|
| Rate for Payer: BCBS Trust/PPO |
$833.59
|
| Rate for Payer: BCN Commercial |
$788.37
|
| Rate for Payer: BCN Medicare Advantage |
$253.50
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$872.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.50
|
| Rate for Payer: Healthscope Commercial |
$912.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$760.48
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.17
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.88
|
| Rate for Payer: Nomi Health Commercial |
$831.46
|
| Rate for Payer: PACE Senior Care Partners |
$240.82
|
| Rate for Payer: PACE SWMI |
$253.50
|
| Rate for Payer: PHP Commercial |
$861.88
|
| Rate for Payer: PHP Medicare Advantage |
$253.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.09
|
| Rate for Payer: Priority Health HMO/PPO |
$882.16
|
| Rate for Payer: Priority Health Medicare |
$256.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$679.37
|
| Rate for Payer: Railroad Medicare Medicare |
$253.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$892.30
|
| Rate for Payer: UHC Core |
$846.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.50
|
| Rate for Payer: UHC Exchange |
$253.50
|
| Rate for Payer: UHC Medicare Advantage |
$253.50
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$253.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$760.48
|
|
