|
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 |
$1,395.22 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,752.18
|
| Rate for Payer: BCN Commercial |
$1,658.81
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,438.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.91
|
| Rate for Payer: UHC Core |
$1,792.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.87
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna Medicare |
$558.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$670.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$670.78
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$536.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.63
|
| Rate for Payer: BCN Commercial |
$1,668.90
|
| Rate for Payer: BCN Medicare Advantage |
$536.62
|
| 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: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.62
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.87
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.45
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: PACE Senior Care Partners |
$509.79
|
| Rate for Payer: PACE SWMI |
$536.62
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: PHP Medicare Advantage |
$536.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,867.45
|
| Rate for Payer: Priority Health Medicare |
$541.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,438.15
|
| Rate for Payer: Railroad Medicare Medicare |
$536.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.91
|
| Rate for Payer: UHC Core |
$1,792.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.62
|
| Rate for Payer: UHC Exchange |
$536.62
|
| Rate for Payer: UHC Medicare Advantage |
$536.62
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$536.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.87
|
|
|
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 |
$174.76 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Medicare |
$529.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.98
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$508.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.07
|
| Rate for Payer: BCN Commercial |
$1,582.31
|
| Rate for Payer: BCN Medicare Advantage |
$508.78
|
| 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: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.78
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.34
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.22
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$585.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: PACE Senior Care Partners |
$483.34
|
| Rate for Payer: PACE SWMI |
$508.78
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Medicare Advantage |
$508.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.55
|
| Rate for Payer: Priority Health Medicare |
$513.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.53
|
| Rate for Payer: Railroad Medicare Medicare |
$508.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.91
|
| Rate for Payer: UHC Core |
$1,699.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.78
|
| Rate for Payer: UHC Exchange |
$508.78
|
| Rate for Payer: UHC Medicare Advantage |
$508.78
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$508.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.34
|
|
|
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 |
$1,322.83 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.27
|
| Rate for Payer: BCN Commercial |
$1,572.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,526.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO |
$1,770.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,790.91
|
| Rate for Payer: UHC Core |
$1,699.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,526.34
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna Medicare |
$725.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$871.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$871.48
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$697.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,292.62
|
| Rate for Payer: BCN Commercial |
$2,168.25
|
| Rate for Payer: BCN Medicare Advantage |
$697.18
|
| 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: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.18
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,091.55
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.04
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$801.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: PACE Senior Care Partners |
$662.33
|
| Rate for Payer: PACE SWMI |
$697.18
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: PHP Medicare Advantage |
$697.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,426.20
|
| Rate for Payer: Priority Health Medicare |
$704.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,868.46
|
| Rate for Payer: Railroad Medicare Medicare |
$697.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,454.09
|
| Rate for Payer: UHC Core |
$2,328.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.18
|
| Rate for Payer: UHC Exchange |
$697.18
|
| Rate for Payer: UHC Medicare Advantage |
$697.18
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$697.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,091.55
|
|
|
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 |
$1,812.68 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.45
|
| Rate for Payer: BCN Commercial |
$2,155.14
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,091.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,426.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,868.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,454.09
|
| Rate for Payer: UHC Core |
$2,328.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,091.55
|
|
|
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 |
$1,458.07 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,831.11
|
| Rate for Payer: BCN Commercial |
$1,733.53
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,682.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,951.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,502.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,974.00
|
| Rate for Payer: UHC Core |
$1,873.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,682.38
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna Medicare |
$583.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$700.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$700.99
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$560.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,844.12
|
| Rate for Payer: BCN Commercial |
$1,744.07
|
| Rate for Payer: BCN Medicare Advantage |
$560.79
|
| 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: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.79
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,682.38
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.83
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PACE Senior Care Partners |
$532.76
|
| Rate for Payer: PACE SWMI |
$560.79
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: PHP Medicare Advantage |
$560.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,951.57
|
| Rate for Payer: Priority Health Medicare |
$566.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,502.93
|
| Rate for Payer: Railroad Medicare Medicare |
$560.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,974.00
|
| Rate for Payer: UHC Core |
$1,873.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.79
|
| Rate for Payer: UHC Exchange |
$560.79
|
| Rate for Payer: UHC Medicare Advantage |
$560.79
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$560.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,682.38
|
|
|
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 |
$1,321.28 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,659.33
|
| Rate for Payer: BCN Commercial |
$1,570.90
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,524.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,768.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.81
|
| Rate for Payer: UHC Core |
$1,697.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,524.56
|
|
|
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 |
$174.76 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: Aetna Medicare |
$528.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.23
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$508.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.12
|
| Rate for Payer: BCN Commercial |
$1,580.46
|
| Rate for Payer: BCN Medicare Advantage |
$508.19
|
| 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: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.19
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,524.56
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.59
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: PACE Senior Care Partners |
$482.78
|
| Rate for Payer: PACE SWMI |
$508.19
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: PHP Medicare Advantage |
$508.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,768.48
|
| Rate for Payer: Priority Health Medicare |
$513.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.94
|
| Rate for Payer: Railroad Medicare Medicare |
$508.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.81
|
| Rate for Payer: UHC Core |
$1,697.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.19
|
| Rate for Payer: UHC Exchange |
$508.19
|
| Rate for Payer: UHC Medicare Advantage |
$508.19
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$508.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,524.56
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: Aetna Medicare |
$792.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$952.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$952.86
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$762.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,506.71
|
| Rate for Payer: BCN Commercial |
$2,370.72
|
| Rate for Payer: BCN Medicare Advantage |
$762.29
|
| 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: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.29
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,286.87
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.40
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$876.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: PACE Senior Care Partners |
$724.18
|
| Rate for Payer: PACE SWMI |
$762.29
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: PHP Medicare Advantage |
$762.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,652.77
|
| Rate for Payer: Priority Health Medicare |
$769.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.94
|
| Rate for Payer: Railroad Medicare Medicare |
$762.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,683.26
|
| Rate for Payer: UHC Core |
$2,546.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.29
|
| Rate for Payer: UHC Exchange |
$762.29
|
| Rate for Payer: UHC Medicare Advantage |
$762.29
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$762.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,286.87
|
|
|
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 |
$1,981.95 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$2,591.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,489.03
|
| Rate for Payer: BCN Commercial |
$2,356.39
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,622.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Healthscope Commercial |
$2,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,286.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: PHP Commercial |
$2,591.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,652.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,042.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,683.26
|
| Rate for Payer: UHC Core |
$2,546.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,286.87
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,235.10 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.10
|
| Rate for Payer: BCN Commercial |
$1,468.44
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,634.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,653.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.14
|
| Rate for Payer: UHC Core |
$1,586.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.12
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$1,710.14 |
| Rate for Payer: Aetna Commercial |
$1,615.14
|
| Rate for Payer: Aetna Medicare |
$494.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.80
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$475.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.12
|
| Rate for Payer: BCN Commercial |
$1,477.37
|
| Rate for Payer: BCN Medicare Advantage |
$475.04
|
| 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: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.04
|
| Rate for Payer: Healthscope Commercial |
$1,710.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,425.12
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.79
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: PACE Senior Care Partners |
$451.29
|
| Rate for Payer: PACE SWMI |
$475.04
|
| Rate for Payer: PHP Commercial |
$1,615.14
|
| Rate for Payer: PHP Medicare Advantage |
$475.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,653.14
|
| Rate for Payer: Priority Health Medicare |
$479.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,273.11
|
| Rate for Payer: Railroad Medicare Medicare |
$475.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.14
|
| Rate for Payer: UHC Core |
$1,586.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.04
|
| Rate for Payer: UHC Exchange |
$475.04
|
| Rate for Payer: UHC Medicare Advantage |
$475.04
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$475.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,425.12
|
|
|
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 |
$1,509.52 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.73
|
| Rate for Payer: BCN Commercial |
$1,794.70
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$1,997.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,020.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,555.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,043.66
|
| Rate for Payer: UHC Core |
$1,939.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.76
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$2,090.11 |
| Rate for Payer: Aetna Commercial |
$1,973.99
|
| Rate for Payer: Aetna Medicare |
$603.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$725.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$725.73
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$580.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,909.20
|
| Rate for Payer: BCN Commercial |
$1,805.62
|
| Rate for Payer: BCN Medicare Advantage |
$580.59
|
| 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: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.59
|
| Rate for Payer: Healthscope Commercial |
$2,090.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.76
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.61
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$667.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: PACE Senior Care Partners |
$551.56
|
| Rate for Payer: PACE SWMI |
$580.59
|
| Rate for Payer: PHP Commercial |
$1,973.99
|
| Rate for Payer: PHP Medicare Advantage |
$580.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,020.44
|
| Rate for Payer: Priority Health Medicare |
$586.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,555.97
|
| Rate for Payer: Railroad Medicare Medicare |
$580.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,043.66
|
| Rate for Payer: UHC Core |
$1,939.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.59
|
| Rate for Payer: UHC Exchange |
$580.59
|
| Rate for Payer: UHC Medicare Advantage |
$580.59
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$580.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.76
|
|
|
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 |
$258.20 |
| Max. Negotiated Rate |
$1,044.68 |
| Rate for Payer: Aetna Commercial |
$986.65
|
| Rate for Payer: Aetna Medicare |
$301.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.74
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$290.19
|
| Rate for Payer: BCBS Trust/PPO |
$954.26
|
| Rate for Payer: BCN Commercial |
$902.49
|
| Rate for Payer: BCN Medicare Advantage |
$290.19
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$998.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.19
|
| Rate for Payer: Healthscope Commercial |
$1,044.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.57
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.70
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: Nomi Health Commercial |
$951.82
|
| Rate for Payer: PACE Senior Care Partners |
$275.68
|
| Rate for Payer: PACE SWMI |
$290.19
|
| Rate for Payer: PHP Commercial |
$986.65
|
| Rate for Payer: PHP Medicare Advantage |
$290.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,009.86
|
| Rate for Payer: Priority Health Medicare |
$293.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$777.71
|
| Rate for Payer: Railroad Medicare Medicare |
$290.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.47
|
| Rate for Payer: UHC Core |
$969.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.19
|
| Rate for Payer: UHC Exchange |
$290.19
|
| Rate for Payer: UHC Medicare Advantage |
$290.19
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$290.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.57
|
|
|
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 |
$754.49 |
| Max. Negotiated Rate |
$1,044.68 |
| Rate for Payer: Aetna Commercial |
$986.65
|
| Rate for Payer: BCBS Trust/PPO |
$947.53
|
| Rate for Payer: BCN Commercial |
$897.04
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$998.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Healthscope Commercial |
$1,044.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: Nomi Health Commercial |
$951.82
|
| Rate for Payer: PHP Commercial |
$986.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,009.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$777.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.47
|
| Rate for Payer: UHC Core |
$969.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.57
|
|
|
HC MR SPINE CERVICAL WO CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna Medicare |
$594.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.01
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$572.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.00
|
| Rate for Payer: BCN Commercial |
$1,778.95
|
| Rate for Payer: BCN Medicare Advantage |
$572.01
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.01
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.61
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: PACE Senior Care Partners |
$543.41
|
| Rate for Payer: PACE SWMI |
$572.01
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: PHP Medicare Advantage |
$572.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Medicare |
$577.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,532.99
|
| Rate for Payer: Railroad Medicare Medicare |
$572.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.01
|
| Rate for Payer: UHC Exchange |
$572.01
|
| Rate for Payer: UHC Medicare Advantage |
$572.01
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$572.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC MR SPINE CERVICAL WO CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,487.23 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,867.73
|
| Rate for Payer: BCN Commercial |
$1,768.20
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,532.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC MR SPINE CERVICAL WO LIMITED
|
Facility
|
OP
|
$1,144.44
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200001
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$972.77
|
| Rate for Payer: Aetna Medicare |
$297.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.64
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$286.11
|
| Rate for Payer: BCBS Trust/PPO |
$940.84
|
| Rate for Payer: BCN Commercial |
$889.80
|
| Rate for Payer: BCN Medicare Advantage |
$286.11
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cofinity Commercial |
$984.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.11
|
| Rate for Payer: Healthscope Commercial |
$1,030.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$858.33
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.42
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.77
|
| Rate for Payer: Nomi Health Commercial |
$938.44
|
| Rate for Payer: PACE Senior Care Partners |
$271.80
|
| Rate for Payer: PACE SWMI |
$286.11
|
| Rate for Payer: PHP Commercial |
$972.77
|
| Rate for Payer: PHP Medicare Advantage |
$286.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.89
|
| Rate for Payer: Priority Health HMO/PPO |
$995.66
|
| Rate for Payer: Priority Health Medicare |
$288.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.77
|
| Rate for Payer: Railroad Medicare Medicare |
$286.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.11
|
| Rate for Payer: UHC Core |
$955.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.11
|
| Rate for Payer: UHC Exchange |
$286.11
|
| Rate for Payer: UHC Medicare Advantage |
$286.11
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$286.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$858.33
|
|
|
HC MR SPINE CERVICAL WO LIMITED
|
Facility
|
IP
|
$1,144.44
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200001
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$743.89 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$972.77
|
| Rate for Payer: BCBS Trust/PPO |
$934.21
|
| Rate for Payer: BCN Commercial |
$884.42
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cofinity Commercial |
$984.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.55
|
| Rate for Payer: Healthscope Commercial |
$1,030.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$858.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.77
|
| Rate for Payer: Nomi Health Commercial |
$938.44
|
| Rate for Payer: PHP Commercial |
$972.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.89
|
| Rate for Payer: Priority Health HMO/PPO |
$995.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.11
|
| Rate for Payer: UHC Core |
$955.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$858.33
|
|
|
HC MR SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,771.89
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,801.73 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Aetna Commercial |
$2,356.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.69
|
| Rate for Payer: BCN Commercial |
$2,142.12
|
| Rate for Payer: Cash Price |
$2,217.51
|
| Rate for Payer: Cofinity Commercial |
$2,383.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.51
|
| Rate for Payer: Healthscope Commercial |
$2,494.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,078.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,356.11
|
| Rate for Payer: Nomi Health Commercial |
$2,272.95
|
| Rate for Payer: PHP Commercial |
$2,356.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,411.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,857.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,439.26
|
| Rate for Payer: UHC Core |
$2,314.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,078.92
|
|
|
HC MR SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,771.89
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$258.20 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Aetna Commercial |
$2,356.11
|
| Rate for Payer: Aetna Medicare |
$720.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$866.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$866.22
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$692.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,278.77
|
| Rate for Payer: BCN Commercial |
$2,155.14
|
| Rate for Payer: BCN Medicare Advantage |
$692.97
|
| Rate for Payer: Cash Price |
$2,217.51
|
| Rate for Payer: Cash Price |
$2,217.51
|
| Rate for Payer: Cofinity Commercial |
$2,383.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.97
|
| Rate for Payer: Healthscope Commercial |
$2,494.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,078.92
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$727.62
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,356.11
|
| Rate for Payer: Nomi Health Commercial |
$2,272.95
|
| Rate for Payer: PACE Senior Care Partners |
$658.32
|
| Rate for Payer: PACE SWMI |
$692.97
|
| Rate for Payer: PHP Commercial |
$2,356.11
|
| Rate for Payer: PHP Medicare Advantage |
$692.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,411.54
|
| Rate for Payer: Priority Health Medicare |
$699.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,857.17
|
| Rate for Payer: Railroad Medicare Medicare |
$692.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,439.26
|
| Rate for Payer: UHC Core |
$2,314.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.97
|
| Rate for Payer: UHC Exchange |
$692.97
|
| Rate for Payer: UHC Medicare Advantage |
$692.97
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$692.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,078.92
|
|
|
HC MR SPINE CERVICAL WO W LTD
|
Facility
|
IP
|
$888.92
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$577.80 |
| Max. Negotiated Rate |
$800.03 |
| Rate for Payer: Aetna Commercial |
$755.58
|
| Rate for Payer: BCBS Trust/PPO |
$725.63
|
| Rate for Payer: BCN Commercial |
$686.96
|
| Rate for Payer: Cash Price |
$711.14
|
| Rate for Payer: Cofinity Commercial |
$764.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$711.14
|
| Rate for Payer: Healthscope Commercial |
$800.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$666.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$755.58
|
| Rate for Payer: Nomi Health Commercial |
$728.91
|
| Rate for Payer: PHP Commercial |
$755.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.80
|
| Rate for Payer: Priority Health HMO/PPO |
$773.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$595.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.25
|
| Rate for Payer: UHC Core |
$742.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$666.69
|
|
