|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
IP
|
$2,635.11
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,844.58 |
| Max. Negotiated Rate |
$2,635.11 |
| Rate for Payer: Aetna Commercial |
$2,371.60
|
| Rate for Payer: Aetna Commercial |
$1,581.07
|
| Rate for Payer: ASR ASR |
$1,704.04
|
| Rate for Payer: ASR ASR |
$2,556.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,043.00
|
| Rate for Payer: BCN Commercial |
$2,043.00
|
| Rate for Payer: BCN Commercial |
$1,362.00
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cofinity Commercial |
$1,651.34
|
| Rate for Payer: Cofinity Commercial |
$2,477.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Healthscope Commercial |
$1,756.74
|
| Rate for Payer: Healthscope Commercial |
$2,635.11
|
| Rate for Payer: Healthscope Whirlpool |
$2,556.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.04
|
| Rate for Payer: Mclaren Commercial |
$2,371.60
|
| Rate for Payer: Mclaren Commercial |
$1,581.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,493.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,239.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,545.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,318.90
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
OP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,049.38 |
| Rate for Payer: Aetna Commercial |
$1,844.44
|
| Rate for Payer: Aetna Commercial |
$2,766.66
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,981.85
|
| Rate for Payer: ASR ASR |
$1,987.90
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.33
|
| Rate for Payer: BCN Commercial |
$1,588.88
|
| Rate for Payer: BCN Commercial |
$2,383.33
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cofinity Commercial |
$1,926.42
|
| Rate for Payer: Cofinity Commercial |
$2,889.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$3,074.07
|
| Rate for Payer: Healthscope Commercial |
$2,049.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,987.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,981.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,766.66
|
| Rate for Payer: Mclaren Commercial |
$1,844.44
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,741.97
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,797.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,864.94
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,455.06
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,803.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,705.18
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,434.57 |
| Max. Negotiated Rate |
$2,049.38 |
| Rate for Payer: Aetna Commercial |
$1,844.44
|
| Rate for Payer: Aetna Commercial |
$2,766.66
|
| Rate for Payer: ASR ASR |
$1,987.90
|
| Rate for Payer: ASR ASR |
$2,981.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.88
|
| Rate for Payer: BCN Commercial |
$1,588.88
|
| Rate for Payer: BCN Commercial |
$2,383.33
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$1,926.42
|
| Rate for Payer: Cofinity Commercial |
$2,889.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Healthscope Commercial |
$2,049.38
|
| Rate for Payer: Healthscope Commercial |
$3,074.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,987.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,981.85
|
| Rate for Payer: Mclaren Commercial |
$2,766.66
|
| Rate for Payer: Mclaren Commercial |
$1,844.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,741.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,705.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,803.45
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$2,069.07 |
| Rate for Payer: Aetna Commercial |
$1,862.16
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$2,007.00
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.15
|
| Rate for Payer: BCN Commercial |
$1,604.15
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,944.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$2,069.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,007.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,862.16
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,425.87
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.70
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,820.78
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,069.07
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,448.35 |
| Max. Negotiated Rate |
$2,069.07 |
| Rate for Payer: Aetna Commercial |
$1,862.16
|
| Rate for Payer: ASR ASR |
$2,007.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.15
|
| Rate for Payer: BCN Commercial |
$1,604.15
|
| Rate for Payer: Cash Price |
$1,655.26
|
| Rate for Payer: Cofinity Commercial |
$1,944.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,655.26
|
| Rate for Payer: Healthscope Commercial |
$2,069.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,007.00
|
| Rate for Payer: Mclaren Commercial |
$1,862.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,758.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,820.78
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$985.70
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$394.28 |
| Max. Negotiated Rate |
$985.70 |
| Rate for Payer: Aetna Commercial |
$887.13
|
| Rate for Payer: ASR ASR |
$956.13
|
| Rate for Payer: BCBS Complete |
$394.28
|
| Rate for Payer: BCBS Trust/PPO |
$764.21
|
| Rate for Payer: BCN Commercial |
$764.21
|
| Rate for Payer: Cash Price |
$788.56
|
| Rate for Payer: Cofinity Commercial |
$926.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.56
|
| Rate for Payer: Healthscope Commercial |
$985.70
|
| Rate for Payer: Healthscope Whirlpool |
$956.13
|
| Rate for Payer: Mclaren Commercial |
$887.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$837.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$896.99
|
| Rate for Payer: Priority Health Narrow Network |
$699.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.42
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$985.70
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$689.99 |
| Max. Negotiated Rate |
$985.70 |
| Rate for Payer: Aetna Commercial |
$887.13
|
| Rate for Payer: ASR ASR |
$956.13
|
| Rate for Payer: BCBS Trust/PPO |
$764.21
|
| Rate for Payer: BCN Commercial |
$764.21
|
| Rate for Payer: Cash Price |
$788.56
|
| Rate for Payer: Cofinity Commercial |
$926.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.56
|
| Rate for Payer: Healthscope Commercial |
$985.70
|
| Rate for Payer: Healthscope Whirlpool |
$956.13
|
| Rate for Payer: Mclaren Commercial |
$887.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$837.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.42
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,173.50
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,521.45 |
| Max. Negotiated Rate |
$2,173.50 |
| Rate for Payer: Aetna Commercial |
$1,956.15
|
| Rate for Payer: ASR ASR |
$2,108.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.11
|
| Rate for Payer: BCN Commercial |
$1,685.11
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cofinity Commercial |
$2,043.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.80
|
| Rate for Payer: Healthscope Commercial |
$2,173.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,108.30
|
| Rate for Payer: Mclaren Commercial |
$1,956.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,847.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,912.68
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,173.50
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,173.50 |
| Rate for Payer: Aetna Commercial |
$1,956.15
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,108.30
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.11
|
| Rate for Payer: BCN Commercial |
$1,685.11
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cofinity Commercial |
$2,043.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,738.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,173.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,108.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,956.15
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,847.48
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,643.94
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,315.15
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,912.68
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,104.40
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,473.08 |
| Max. Negotiated Rate |
$2,104.40 |
| Rate for Payer: Aetna Commercial |
$1,893.96
|
| Rate for Payer: ASR ASR |
$2,041.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.54
|
| Rate for Payer: BCN Commercial |
$1,631.54
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cofinity Commercial |
$1,978.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,683.52
|
| Rate for Payer: Healthscope Commercial |
$2,104.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,041.27
|
| Rate for Payer: Mclaren Commercial |
$1,893.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,851.87
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,104.40
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,104.40 |
| Rate for Payer: Aetna Commercial |
$1,893.96
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,041.27
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.54
|
| Rate for Payer: BCN Commercial |
$1,631.54
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cash Price |
$1,683.52
|
| Rate for Payer: Cofinity Commercial |
$1,978.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,683.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,104.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,041.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,893.96
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,788.74
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,851.87
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$1,995.22
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,396.65 |
| Max. Negotiated Rate |
$1,995.22 |
| Rate for Payer: Aetna Commercial |
$1,795.70
|
| Rate for Payer: ASR ASR |
$1,935.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.89
|
| Rate for Payer: BCN Commercial |
$1,546.89
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cofinity Commercial |
$1,875.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Healthscope Commercial |
$1,995.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.36
|
| Rate for Payer: Mclaren Commercial |
$1,795.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.79
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$1,995.22
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,995.22 |
| Rate for Payer: Aetna Commercial |
$1,795.70
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,935.36
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.89
|
| Rate for Payer: BCN Commercial |
$1,546.89
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cofinity Commercial |
$1,875.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,995.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,935.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,795.70
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,695.94
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.64
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.51
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.79
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,734.06
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,734.06 |
| Rate for Payer: Aetna Commercial |
$2,460.65
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,652.04
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.72
|
| Rate for Payer: BCN Commercial |
$2,119.72
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cofinity Commercial |
$2,570.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,734.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,652.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,460.65
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,323.95
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,942.04
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.63
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,405.97
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,734.06
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,913.84 |
| Max. Negotiated Rate |
$2,734.06 |
| Rate for Payer: Aetna Commercial |
$2,460.65
|
| Rate for Payer: ASR ASR |
$2,652.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.72
|
| Rate for Payer: BCN Commercial |
$2,119.72
|
| Rate for Payer: Cash Price |
$2,187.25
|
| Rate for Payer: Cofinity Commercial |
$2,570.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,187.25
|
| Rate for Payer: Healthscope Commercial |
$2,734.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,652.04
|
| Rate for Payer: Mclaren Commercial |
$2,460.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,323.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,913.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,405.97
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,199.20
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,199.20 |
| Rate for Payer: Aetna Commercial |
$1,979.28
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,133.22
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,705.04
|
| Rate for Payer: BCN Commercial |
$1,705.04
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$2,067.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,199.20
|
| Rate for Payer: Healthscope Whirlpool |
$2,133.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,979.28
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,755.28
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.22
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,935.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,199.20
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,539.44 |
| Max. Negotiated Rate |
$2,199.20 |
| Rate for Payer: Aetna Commercial |
$1,979.28
|
| Rate for Payer: ASR ASR |
$2,133.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,705.04
|
| Rate for Payer: BCN Commercial |
$1,705.04
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$2,067.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Healthscope Commercial |
$2,199.20
|
| Rate for Payer: Healthscope Whirlpool |
$2,133.22
|
| Rate for Payer: Mclaren Commercial |
$1,979.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,935.30
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$1,992.88
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,395.02 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,793.59
|
| Rate for Payer: ASR ASR |
$1,933.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.08
|
| Rate for Payer: BCN Commercial |
$1,545.08
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cofinity Commercial |
$1,873.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,594.30
|
| Rate for Payer: Healthscope Commercial |
$1,992.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,933.09
|
| Rate for Payer: Mclaren Commercial |
$1,793.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.73
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$1,992.88
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,992.88 |
| Rate for Payer: Aetna Commercial |
$1,793.59
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,933.09
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.08
|
| Rate for Payer: BCN Commercial |
$1,545.08
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cash Price |
$1,594.30
|
| Rate for Payer: Cofinity Commercial |
$1,873.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,594.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,992.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,933.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,793.59
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.95
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,550.04
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,240.03
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,753.73
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$2,989.37
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,989.37 |
| Rate for Payer: Aetna Commercial |
$2,690.43
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,899.69
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.66
|
| Rate for Payer: BCN Commercial |
$2,317.66
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cofinity Commercial |
$2,810.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,989.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,690.43
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.96
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,109.83
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,687.86
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.65
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$2,989.37
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,092.56 |
| Max. Negotiated Rate |
$2,989.37 |
| Rate for Payer: Aetna Commercial |
$2,690.43
|
| Rate for Payer: ASR ASR |
$2,899.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.66
|
| Rate for Payer: BCN Commercial |
$2,317.66
|
| Rate for Payer: Cash Price |
$2,391.50
|
| Rate for Payer: Cofinity Commercial |
$2,810.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.50
|
| Rate for Payer: Healthscope Commercial |
$2,989.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.69
|
| Rate for Payer: Mclaren Commercial |
$2,690.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.65
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,862.90
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$1,862.90 |
| Rate for Payer: Aetna Commercial |
$1,676.61
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$1,807.01
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.31
|
| Rate for Payer: BCN Commercial |
$1,444.31
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cofinity Commercial |
$1,751.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,490.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$1,862.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,807.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$1,676.61
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,583.46
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,304.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,695.24
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,322.66
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,639.35
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,862.90
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,304.03 |
| Max. Negotiated Rate |
$1,862.90 |
| Rate for Payer: Aetna Commercial |
$1,676.61
|
| Rate for Payer: ASR ASR |
$1,807.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.31
|
| Rate for Payer: BCN Commercial |
$1,444.31
|
| Rate for Payer: Cash Price |
$1,490.32
|
| Rate for Payer: Cofinity Commercial |
$1,751.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,490.32
|
| Rate for Payer: Healthscope Commercial |
$1,862.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,807.01
|
| Rate for Payer: Mclaren Commercial |
$1,676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,583.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,304.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,639.35
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,276.80
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,276.80 |
| Rate for Payer: Aetna Commercial |
$2,049.12
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,208.50
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,765.20
|
| Rate for Payer: BCN Commercial |
$1,765.20
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,821.44
|
| Rate for Payer: Cash Price |
$1,821.44
|
| Rate for Payer: Cofinity Commercial |
$2,140.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,276.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,049.12
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,935.28
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,593.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.84
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.07
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.58
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,276.80
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,593.76 |
| Max. Negotiated Rate |
$2,276.80 |
| Rate for Payer: Aetna Commercial |
$2,049.12
|
| Rate for Payer: ASR ASR |
$2,208.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,765.20
|
| Rate for Payer: BCN Commercial |
$1,765.20
|
| Rate for Payer: Cash Price |
$1,821.44
|
| Rate for Payer: Cofinity Commercial |
$2,140.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.44
|
| Rate for Payer: Healthscope Commercial |
$2,276.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.50
|
| Rate for Payer: Mclaren Commercial |
$2,049.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,935.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,593.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.58
|
|
