|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
IP
|
$1,791.87
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,343.90 |
| Max. Negotiated Rate |
$1,791.87 |
| Rate for Payer: Aetna Commercial |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,419.03
|
| Rate for Payer: ASR ASR |
$1,738.11
|
| Rate for Payer: ASR ASR |
$2,607.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,207.23
|
| Rate for Payer: BCN Commercial |
$1,471.48
|
| Rate for Payer: BCN Commercial |
$2,207.23
|
| Rate for Payer: Cash Price |
$2,150.25
|
| Rate for Payer: Cash Price |
$1,433.50
|
| Rate for Payer: Cofinity Commercial |
$2,526.54
|
| Rate for Payer: Cofinity Commercial |
$1,684.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,150.25
|
| Rate for Payer: Healthscope Commercial |
$1,738.11
|
| Rate for Payer: Healthscope Commercial |
$2,607.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,687.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,791.87
|
| Rate for Payer: Mclaren Commercial |
$2,419.03
|
| Rate for Payer: Mclaren Commercial |
$1,612.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,284.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.09
|
| Rate for Payer: Nomi Health Commercial |
$2,204.00
|
| Rate for Payer: Nomi Health Commercial |
$1,469.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,015.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,365.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,576.85
|
|
|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
OP
|
$1,791.87
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,791.87 |
| Rate for Payer: Aetna Commercial |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,419.03
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$1,738.11
|
| Rate for Payer: ASR ASR |
$2,607.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,216.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.40
|
| Rate for Payer: BCN Commercial |
$2,216.10
|
| Rate for Payer: BCN Commercial |
$1,477.40
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,433.50
|
| Rate for Payer: Cash Price |
$1,433.50
|
| Rate for Payer: Cash Price |
$2,150.25
|
| Rate for Payer: Cash Price |
$2,150.25
|
| Rate for Payer: Cofinity Commercial |
$1,684.36
|
| Rate for Payer: Cofinity Commercial |
$2,526.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,150.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,738.11
|
| Rate for Payer: Healthscope Commercial |
$2,607.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,791.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,687.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,419.03
|
| Rate for Payer: Mclaren Commercial |
$1,612.68
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,284.64
|
| Rate for Payer: Nomi Health Commercial |
$2,204.00
|
| Rate for Payer: Nomi Health Commercial |
$1,469.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,015.86
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,709.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,709.91
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,367.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,367.93
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,365.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,576.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$2,090.37
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,567.78 |
| Max. Negotiated Rate |
$2,090.37 |
| Rate for Payer: Aetna Commercial |
$1,881.33
|
| Rate for Payer: Aetna Commercial |
$2,821.99
|
| Rate for Payer: ASR ASR |
$2,027.66
|
| Rate for Payer: ASR ASR |
$3,041.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,574.91
|
| Rate for Payer: BCN Commercial |
$1,716.61
|
| Rate for Payer: BCN Commercial |
$2,574.91
|
| Rate for Payer: Cash Price |
$2,508.44
|
| Rate for Payer: Cash Price |
$1,672.30
|
| Rate for Payer: Cofinity Commercial |
$2,947.42
|
| Rate for Payer: Cofinity Commercial |
$1,964.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,508.44
|
| Rate for Payer: Healthscope Commercial |
$2,027.66
|
| Rate for Payer: Healthscope Commercial |
$3,041.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,135.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,090.37
|
| Rate for Payer: Mclaren Commercial |
$2,821.99
|
| Rate for Payer: Mclaren Commercial |
$1,881.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,665.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,776.81
|
| Rate for Payer: Nomi Health Commercial |
$2,571.15
|
| Rate for Payer: Nomi Health Commercial |
$1,714.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,567.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,351.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,759.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,839.53
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
OP
|
$2,090.37
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,090.37 |
| Rate for Payer: Aetna Commercial |
$1,881.33
|
| Rate for Payer: Aetna Commercial |
$2,821.99
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$3,041.48
|
| Rate for Payer: ASR ASR |
$2,027.66
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,585.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,723.51
|
| Rate for Payer: BCN Commercial |
$1,723.51
|
| Rate for Payer: BCN Commercial |
$2,585.26
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,672.30
|
| Rate for Payer: Cash Price |
$1,672.30
|
| Rate for Payer: Cash Price |
$2,508.44
|
| Rate for Payer: Cash Price |
$2,508.44
|
| Rate for Payer: Cofinity Commercial |
$1,964.95
|
| Rate for Payer: Cofinity Commercial |
$2,947.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,508.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,027.66
|
| Rate for Payer: Healthscope Commercial |
$3,041.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,135.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,090.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,821.99
|
| Rate for Payer: Mclaren Commercial |
$1,881.33
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,665.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,776.81
|
| Rate for Payer: Nomi Health Commercial |
$1,714.10
|
| Rate for Payer: Nomi Health Commercial |
$2,571.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,351.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,567.78
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,831.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,747.37
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,465.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,198.02
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,839.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,759.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,152.66
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,152.66 |
| Rate for Payer: Aetna Commercial |
$1,937.39
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$2,088.08
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.87
|
| Rate for Payer: BCN Commercial |
$1,774.87
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,722.13
|
| Rate for Payer: Cash Price |
$1,722.13
|
| Rate for Payer: Cofinity Commercial |
$2,023.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,088.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$1,937.39
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.76
|
| Rate for Payer: Nomi Health Commercial |
$1,765.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.49
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,682.06
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,345.65
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,894.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,152.66
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,614.49 |
| Max. Negotiated Rate |
$2,152.66 |
| Rate for Payer: Aetna Commercial |
$1,937.39
|
| Rate for Payer: ASR ASR |
$2,088.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.76
|
| Rate for Payer: BCN Commercial |
$1,767.76
|
| Rate for Payer: Cash Price |
$1,722.13
|
| Rate for Payer: Cofinity Commercial |
$2,023.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.13
|
| Rate for Payer: Healthscope Commercial |
$2,088.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.66
|
| Rate for Payer: Mclaren Commercial |
$1,937.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.76
|
| Rate for Payer: Nomi Health Commercial |
$1,765.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,894.34
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,025.52
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$769.14 |
| Max. Negotiated Rate |
$1,025.52 |
| Rate for Payer: Aetna Commercial |
$922.97
|
| Rate for Payer: ASR ASR |
$994.75
|
| Rate for Payer: BCBS Trust/PPO |
$842.16
|
| Rate for Payer: BCN Commercial |
$842.16
|
| Rate for Payer: Cash Price |
$820.42
|
| Rate for Payer: Cofinity Commercial |
$963.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.42
|
| Rate for Payer: Healthscope Commercial |
$994.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,025.52
|
| Rate for Payer: Mclaren Commercial |
$922.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$871.69
|
| Rate for Payer: Nomi Health Commercial |
$840.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$902.46
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,025.52
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$379.44 |
| Max. Negotiated Rate |
$1,025.52 |
| Rate for Payer: Aetna Commercial |
$922.97
|
| Rate for Payer: Aetna Medicare |
$379.44
|
| Rate for Payer: ASR ASR |
$994.75
|
| Rate for Payer: BCBS Complete |
$410.21
|
| Rate for Payer: BCBS Trust/PPO |
$845.54
|
| Rate for Payer: BCN Commercial |
$845.54
|
| Rate for Payer: Cash Price |
$820.42
|
| Rate for Payer: Cofinity Commercial |
$963.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.42
|
| Rate for Payer: Healthscope Commercial |
$994.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,025.52
|
| Rate for Payer: Mclaren Commercial |
$922.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$820.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$871.69
|
| Rate for Payer: Nomi Health Commercial |
$840.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$898.56
|
| Rate for Payer: Priority Health Narrow Network |
$718.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$902.46
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,261.31
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,261.31 |
| Rate for Payer: Aetna Commercial |
$2,035.18
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,193.47
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.45
|
| Rate for Payer: BCN Commercial |
$1,864.45
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,809.05
|
| Rate for Payer: Cash Price |
$1,809.05
|
| Rate for Payer: Cofinity Commercial |
$2,125.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,809.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,261.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,035.18
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,922.11
|
| Rate for Payer: Nomi Health Commercial |
$1,854.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,695.98
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,939.32
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,551.45
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,989.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,261.31
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,695.98 |
| Max. Negotiated Rate |
$2,261.31 |
| Rate for Payer: Aetna Commercial |
$2,035.18
|
| Rate for Payer: ASR ASR |
$2,193.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,856.99
|
| Rate for Payer: BCN Commercial |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,809.05
|
| Rate for Payer: Cofinity Commercial |
$2,125.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,809.05
|
| Rate for Payer: Healthscope Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Whirlpool |
$2,261.31
|
| Rate for Payer: Mclaren Commercial |
$2,035.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,922.11
|
| Rate for Payer: Nomi Health Commercial |
$1,854.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,695.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,989.95
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,189.42
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,189.42 |
| Rate for Payer: Aetna Commercial |
$1,970.48
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,123.74
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.18
|
| Rate for Payer: BCN Commercial |
$1,805.18
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cofinity Commercial |
$2,058.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,123.74
|
| Rate for Payer: Healthscope Whirlpool |
$2,189.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,970.48
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.01
|
| Rate for Payer: Nomi Health Commercial |
$1,795.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.07
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,189.42
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,642.07 |
| Max. Negotiated Rate |
$2,189.42 |
| Rate for Payer: Aetna Commercial |
$1,970.48
|
| Rate for Payer: ASR ASR |
$2,123.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.95
|
| Rate for Payer: BCN Commercial |
$1,797.95
|
| Rate for Payer: Cash Price |
$1,751.54
|
| Rate for Payer: Cofinity Commercial |
$2,058.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.54
|
| Rate for Payer: Healthscope Commercial |
$2,123.74
|
| Rate for Payer: Healthscope Whirlpool |
$2,189.42
|
| Rate for Payer: Mclaren Commercial |
$1,970.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.01
|
| Rate for Payer: Nomi Health Commercial |
$1,795.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.69
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,556.87 |
| Max. Negotiated Rate |
$2,075.82 |
| Rate for Payer: Aetna Commercial |
$1,868.24
|
| Rate for Payer: ASR ASR |
$2,013.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.66
|
| Rate for Payer: BCN Commercial |
$1,704.66
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Commercial |
$1,951.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Healthscope Commercial |
$2,013.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,075.82
|
| Rate for Payer: Mclaren Commercial |
$1,868.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Nomi Health Commercial |
$1,702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,826.72
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,075.82
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,075.82 |
| Rate for Payer: Aetna Commercial |
$1,868.24
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$2,013.55
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.51
|
| Rate for Payer: BCN Commercial |
$1,711.51
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cash Price |
$1,660.66
|
| Rate for Payer: Cofinity Commercial |
$1,951.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,660.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,013.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,075.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$1,868.24
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,764.45
|
| Rate for Payer: Nomi Health Commercial |
$1,702.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.87
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,826.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,844.51 |
| Rate for Payer: Aetna Commercial |
$2,560.06
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,759.17
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,345.30
|
| Rate for Payer: BCN Commercial |
$2,345.30
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Commercial |
$2,673.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,759.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,844.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,560.06
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Nomi Health Commercial |
$2,332.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,290.97
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,832.78
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,503.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,844.51
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,133.38 |
| Max. Negotiated Rate |
$2,844.51 |
| Rate for Payer: Aetna Commercial |
$2,560.06
|
| Rate for Payer: ASR ASR |
$2,759.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.91
|
| Rate for Payer: BCN Commercial |
$2,335.91
|
| Rate for Payer: Cash Price |
$2,275.61
|
| Rate for Payer: Cofinity Commercial |
$2,673.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,275.61
|
| Rate for Payer: Healthscope Commercial |
$2,759.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,844.51
|
| Rate for Payer: Mclaren Commercial |
$2,560.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,417.83
|
| Rate for Payer: Nomi Health Commercial |
$2,332.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,133.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,503.17
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,716.03 |
| Max. Negotiated Rate |
$2,288.04 |
| Rate for Payer: Aetna Commercial |
$2,059.24
|
| Rate for Payer: ASR ASR |
$2,219.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.94
|
| Rate for Payer: BCN Commercial |
$1,878.94
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$2,150.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Healthscope Commercial |
$2,219.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,288.04
|
| Rate for Payer: Mclaren Commercial |
$2,059.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,013.48
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,288.04 |
| Rate for Payer: Aetna Commercial |
$2,059.24
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,219.40
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.49
|
| Rate for Payer: BCN Commercial |
$1,886.49
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$2,150.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,219.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,288.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,059.24
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,070.66
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,656.53
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,013.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,073.39 |
| Rate for Payer: Aetna Commercial |
$1,866.05
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$2,011.19
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.51
|
| Rate for Payer: BCN Commercial |
$1,709.51
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Commercial |
$1,948.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,011.19
|
| Rate for Payer: Healthscope Whirlpool |
$2,073.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$1,866.05
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Nomi Health Commercial |
$1,700.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,828.54
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,462.83
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,824.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,073.39
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,555.04 |
| Max. Negotiated Rate |
$2,073.39 |
| Rate for Payer: Aetna Commercial |
$1,866.05
|
| Rate for Payer: ASR ASR |
$2,011.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,702.67
|
| Rate for Payer: BCN Commercial |
$1,702.67
|
| Rate for Payer: Cash Price |
$1,658.71
|
| Rate for Payer: Cofinity Commercial |
$1,948.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.71
|
| Rate for Payer: Healthscope Commercial |
$2,011.19
|
| Rate for Payer: Healthscope Whirlpool |
$2,073.39
|
| Rate for Payer: Mclaren Commercial |
$1,866.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,762.38
|
| Rate for Payer: Nomi Health Commercial |
$1,700.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,555.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,824.58
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$3,110.14 |
| Rate for Payer: Aetna Commercial |
$2,799.13
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$3,016.84
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,564.31
|
| Rate for Payer: BCN Commercial |
$2,564.31
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Commercial |
$2,923.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$3,016.84
|
| Rate for Payer: Healthscope Whirlpool |
$3,110.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,799.13
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Nomi Health Commercial |
$2,550.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,488.92
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,991.14
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,736.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,110.14
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,332.61 |
| Max. Negotiated Rate |
$3,110.14 |
| Rate for Payer: Aetna Commercial |
$2,799.13
|
| Rate for Payer: ASR ASR |
$3,016.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.05
|
| Rate for Payer: BCN Commercial |
$2,554.05
|
| Rate for Payer: Cash Price |
$2,488.11
|
| Rate for Payer: Cofinity Commercial |
$2,923.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,488.11
|
| Rate for Payer: Healthscope Commercial |
$3,016.84
|
| Rate for Payer: Healthscope Whirlpool |
$3,110.14
|
| Rate for Payer: Mclaren Commercial |
$2,799.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,643.62
|
| Rate for Payer: Nomi Health Commercial |
$2,550.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,332.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,736.92
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: ASR ASR |
$256.08
|
| Rate for Payer: BCBS Trust/PPO |
$216.80
|
| Rate for Payer: BCN Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$264.00
|
| Rate for Payer: Mclaren Commercial |
$237.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.32
|
|
|
HC MR SAFETY DETERMINATION PHYS/QHP
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
61000098
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$256.08
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$217.67
|
| Rate for Payer: BCN Commercial |
$217.67
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$264.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$237.60
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.07
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$77.66
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC MR SAFETY IMPLANT ELECTRONICS PREP
|
Facility
|
IP
|
$199.92
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
61000095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$199.92 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: ASR ASR |
$193.92
|
| Rate for Payer: BCBS Trust/PPO |
$164.17
|
| Rate for Payer: BCN Commercial |
$164.17
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$187.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$193.92
|
| Rate for Payer: Healthscope Whirlpool |
$199.92
|
| Rate for Payer: Mclaren Commercial |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.93
|
|
