|
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
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$54.06 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$28.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: ASR ASR |
$52.44
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$44.57
|
| Rate for Payer: BCN Commercial |
$44.57
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$54.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.82
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.70
|
| Rate for Payer: PHP Medicaid |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.00
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Narrow Network |
$21.60
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$44.67
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP DNSP |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF 1ST 15 MIN.
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$54.06 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: ASR ASR |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$44.39
|
| Rate for Payer: BCN Commercial |
$44.39
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$54.06
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.57
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$43.93 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: ASR ASR |
$265.78
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.91
|
| Rate for Payer: BCN Commercial |
$225.91
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$257.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$265.78
|
| Rate for Payer: Healthscope Whirlpool |
$274.00
|
| Rate for Payer: Mclaren Commercial |
$246.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.91
|
| Rate for Payer: Priority Health Narrow Network |
$43.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.12
|
|
|
HC MR SAFETY IMPLANT/FB ASSMT CLIN STAFF EA ADD 30 MIN.
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
61000097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: ASR ASR |
$265.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.01
|
| Rate for Payer: BCN Commercial |
$225.01
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$257.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$265.78
|
| Rate for Payer: Healthscope Whirlpool |
$274.00
|
| Rate for Payer: Mclaren Commercial |
$246.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.12
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,453.62 |
| Max. Negotiated Rate |
$1,938.16 |
| Rate for Payer: Aetna Commercial |
$1,744.34
|
| Rate for Payer: ASR ASR |
$1,880.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.62
|
| Rate for Payer: BCN Commercial |
$1,591.62
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Commercial |
$1,821.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Healthscope Commercial |
$1,880.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,938.16
|
| Rate for Payer: Mclaren Commercial |
$1,744.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.44
|
| Rate for Payer: Nomi Health Commercial |
$1,589.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.58
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,938.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$1,938.16 |
| Rate for Payer: Aetna Commercial |
$1,744.34
|
| 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 |
$1,880.02
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.01
|
| Rate for Payer: BCN Commercial |
$1,598.01
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cash Price |
$1,550.53
|
| Rate for Payer: Cofinity Commercial |
$1,821.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$1,880.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,938.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$1,744.34
|
| 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 |
$1,647.44
|
| Rate for Payer: Nomi Health Commercial |
$1,589.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,453.62
|
| 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 |
$1,698.22
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.65
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.58
|
| 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 SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,776.59 |
| Max. Negotiated Rate |
$2,368.79 |
| Rate for Payer: Aetna Commercial |
$2,131.91
|
| Rate for Payer: ASR ASR |
$2,297.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,945.25
|
| Rate for Payer: BCN Commercial |
$1,945.25
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Commercial |
$2,226.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Healthscope Commercial |
$2,297.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,368.79
|
| Rate for Payer: Mclaren Commercial |
$2,131.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.47
|
| Rate for Payer: Nomi Health Commercial |
$1,942.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,084.54
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,368.79
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,368.79 |
| Rate for Payer: Aetna Commercial |
$2,131.91
|
| 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 |
$2,297.73
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.07
|
| Rate for Payer: BCN Commercial |
$1,953.07
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cash Price |
$1,895.03
|
| Rate for Payer: Cofinity Commercial |
$2,226.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,895.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,297.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,368.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,131.91
|
| 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 |
$2,013.47
|
| Rate for Payer: Nomi Health Commercial |
$1,942.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,776.59
|
| 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 |
$2,004.08
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,603.27
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,084.54
|
| 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 SPINE CERVICAL W CON LTD
|
Facility
|
IP
|
$1,183.98
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$887.99 |
| Max. Negotiated Rate |
$1,183.98 |
| Rate for Payer: Aetna Commercial |
$1,065.58
|
| Rate for Payer: ASR ASR |
$1,148.46
|
| Rate for Payer: BCBS Trust/PPO |
$972.28
|
| Rate for Payer: BCN Commercial |
$972.28
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cofinity Commercial |
$1,112.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.18
|
| Rate for Payer: Healthscope Commercial |
$1,148.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,183.98
|
| Rate for Payer: Mclaren Commercial |
$1,065.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.38
|
| Rate for Payer: Nomi Health Commercial |
$970.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,041.90
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
OP
|
$1,183.98
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,004.08 |
| Rate for Payer: Aetna Commercial |
$1,065.58
|
| 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 |
$1,148.46
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$976.19
|
| Rate for Payer: BCN Commercial |
$976.19
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cash Price |
$947.18
|
| Rate for Payer: Cofinity Commercial |
$1,112.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,148.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,183.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,065.58
|
| 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 |
$1,006.38
|
| Rate for Payer: Nomi Health Commercial |
$970.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$887.99
|
| 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 |
$2,004.08
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,603.27
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,041.90
|
| 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 SPINE CERVICAL WO CON
|
Facility
|
OP
|
$2,333.80
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,333.80 |
| Rate for Payer: Aetna Commercial |
$2,100.42
|
| 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 |
$2,263.79
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.22
|
| Rate for Payer: BCN Commercial |
$1,924.22
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,867.04
|
| Rate for Payer: Cash Price |
$1,867.04
|
| Rate for Payer: Cofinity Commercial |
$2,193.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,867.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,263.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,333.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,100.42
|
| 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 |
$1,983.73
|
| Rate for Payer: Nomi Health Commercial |
$1,913.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,750.35
|
| 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 |
$1,723.22
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,378.57
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.74
|
| 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 SPINE CERVICAL WO CON
|
Facility
|
IP
|
$2,333.80
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,750.35 |
| Max. Negotiated Rate |
$2,333.80 |
| Rate for Payer: Aetna Commercial |
$2,100.42
|
| Rate for Payer: ASR ASR |
$2,263.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,916.52
|
| Rate for Payer: BCN Commercial |
$1,916.52
|
| Rate for Payer: Cash Price |
$1,867.04
|
| Rate for Payer: Cofinity Commercial |
$2,193.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,867.04
|
| Rate for Payer: Healthscope Commercial |
$2,263.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,333.80
|
| Rate for Payer: Mclaren Commercial |
$2,100.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.73
|
| Rate for Payer: Nomi Health Commercial |
$1,913.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,750.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.74
|
|
|
HC MR SPINE CERVICAL WO LIMITED
|
Facility
|
IP
|
$1,167.33
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200001
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$875.50 |
| Max. Negotiated Rate |
$1,167.33 |
| Rate for Payer: Aetna Commercial |
$1,050.60
|
| Rate for Payer: ASR ASR |
$1,132.31
|
| Rate for Payer: BCBS Trust/PPO |
$958.61
|
| Rate for Payer: BCN Commercial |
$958.61
|
| Rate for Payer: Cash Price |
$933.86
|
| Rate for Payer: Cofinity Commercial |
$1,097.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.86
|
| Rate for Payer: Healthscope Commercial |
$1,132.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.33
|
| Rate for Payer: Mclaren Commercial |
$1,050.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.23
|
| Rate for Payer: Nomi Health Commercial |
$957.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,027.25
|
|
|
HC MR SPINE CERVICAL WO LIMITED
|
Facility
|
OP
|
$1,167.33
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200001
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,723.22 |
| Rate for Payer: Aetna Commercial |
$1,050.60
|
| 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 |
$1,132.31
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$962.46
|
| Rate for Payer: BCN Commercial |
$962.46
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$933.86
|
| Rate for Payer: Cash Price |
$933.86
|
| Rate for Payer: Cofinity Commercial |
$1,097.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,132.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$1,050.60
|
| 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 |
$992.23
|
| Rate for Payer: Nomi Health Commercial |
$957.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.50
|
| 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 |
$1,723.22
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,378.57
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,027.25
|
| 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 SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,827.33
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,827.33 |
| Rate for Payer: Aetna Commercial |
$2,544.60
|
| 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 |
$2,742.51
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,331.13
|
| Rate for Payer: BCN Commercial |
$2,331.13
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,261.86
|
| Rate for Payer: Cash Price |
$2,261.86
|
| Rate for Payer: Cofinity Commercial |
$2,657.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,261.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,742.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,827.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,544.60
|
| 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 |
$2,403.23
|
| Rate for Payer: Nomi Health Commercial |
$2,318.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,120.50
|
| 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 |
$2,323.06
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.45
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,488.05
|
| 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 SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,827.33
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,120.50 |
| Max. Negotiated Rate |
$2,827.33 |
| Rate for Payer: Aetna Commercial |
$2,544.60
|
| Rate for Payer: ASR ASR |
$2,742.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,321.80
|
| Rate for Payer: BCN Commercial |
$2,321.80
|
| Rate for Payer: Cash Price |
$2,261.86
|
| Rate for Payer: Cofinity Commercial |
$2,657.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,261.86
|
| Rate for Payer: Healthscope Commercial |
$2,742.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,827.33
|
| Rate for Payer: Mclaren Commercial |
$2,544.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,403.23
|
| Rate for Payer: Nomi Health Commercial |
$2,318.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,120.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,488.05
|
|
|
HC MR SPINE CERVICAL WO W LTD
|
Facility
|
OP
|
$906.70
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,323.06 |
| Rate for Payer: Aetna Commercial |
$816.03
|
| 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 |
$879.50
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$747.57
|
| Rate for Payer: BCN Commercial |
$747.57
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$725.36
|
| Rate for Payer: Cash Price |
$725.36
|
| Rate for Payer: Cofinity Commercial |
$852.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$725.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$879.50
|
| Rate for Payer: Healthscope Whirlpool |
$906.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$816.03
|
| 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 |
$770.70
|
| Rate for Payer: Nomi Health Commercial |
$743.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$680.02
|
| 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 |
$2,323.06
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.45
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.90
|
| 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 SPINE CERVICAL WO W LTD
|
Facility
|
IP
|
$906.70
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
61200014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$906.70 |
| Rate for Payer: Aetna Commercial |
$816.03
|
| Rate for Payer: ASR ASR |
$879.50
|
| Rate for Payer: BCBS Trust/PPO |
$744.58
|
| Rate for Payer: BCN Commercial |
$744.58
|
| Rate for Payer: Cash Price |
$725.36
|
| Rate for Payer: Cofinity Commercial |
$852.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$725.36
|
| Rate for Payer: Healthscope Commercial |
$879.50
|
| Rate for Payer: Healthscope Whirlpool |
$906.70
|
| Rate for Payer: Mclaren Commercial |
$816.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$770.70
|
| Rate for Payer: Nomi Health Commercial |
$743.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$680.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.90
|
|
|
HC MR SPINE LUMBAR W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
61200012
|
|
Hospital Revenue Code
|
612
|
| 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 |
$1,902.99
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.39
|
| 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 SPINE LUMBAR W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
61200012
|
|
Hospital Revenue Code
|
612
|
| 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 SPINE LUMBAR W LTD
|
Facility
|
OP
|
$834.11
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
61200011
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,902.99 |
| Rate for Payer: Aetna Commercial |
$750.70
|
| 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 |
$809.09
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$687.72
|
| Rate for Payer: BCN Commercial |
$687.72
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$667.29
|
| Rate for Payer: Cash Price |
$667.29
|
| Rate for Payer: Cofinity Commercial |
$784.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$809.09
|
| Rate for Payer: Healthscope Whirlpool |
$834.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$750.70
|
| 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 |
$708.99
|
| Rate for Payer: Nomi Health Commercial |
$683.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$625.58
|
| 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 |
$1,902.99
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.39
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.02
|
| 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 SPINE LUMBAR W LTD
|
Facility
|
IP
|
$834.11
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
61200011
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$625.58 |
| Max. Negotiated Rate |
$834.11 |
| Rate for Payer: Aetna Commercial |
$750.70
|
| Rate for Payer: ASR ASR |
$809.09
|
| Rate for Payer: BCBS Trust/PPO |
$684.97
|
| Rate for Payer: BCN Commercial |
$684.97
|
| Rate for Payer: Cash Price |
$667.29
|
| Rate for Payer: Cofinity Commercial |
$784.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.29
|
| Rate for Payer: Healthscope Commercial |
$809.09
|
| Rate for Payer: Healthscope Whirlpool |
$834.11
|
| Rate for Payer: Mclaren Commercial |
$750.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.99
|
| Rate for Payer: Nomi Health Commercial |
$683.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$625.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.02
|
|
|
HC MR SPINE LUMBAR WO CON
|
Facility
|
OP
|
$2,325.84
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
61200009
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,325.84 |
| Rate for Payer: Aetna Commercial |
$2,093.26
|
| 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 |
$2,256.06
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.66
|
| Rate for Payer: BCN Commercial |
$1,917.66
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,860.67
|
| Rate for Payer: Cash Price |
$1,860.67
|
| Rate for Payer: Cofinity Commercial |
$2,186.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,860.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,256.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,093.26
|
| 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 |
$1,976.96
|
| Rate for Payer: Nomi Health Commercial |
$1,907.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,744.38
|
| 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 |
$1,709.91
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,367.93
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,046.74
|
| 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 SPINE LUMBAR WO CON
|
Facility
|
IP
|
$2,325.84
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
61200009
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,744.38 |
| Max. Negotiated Rate |
$2,325.84 |
| Rate for Payer: Aetna Commercial |
$2,093.26
|
| Rate for Payer: ASR ASR |
$2,256.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,909.98
|
| Rate for Payer: BCN Commercial |
$1,909.98
|
| Rate for Payer: Cash Price |
$1,860.67
|
| Rate for Payer: Cofinity Commercial |
$2,186.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,860.67
|
| Rate for Payer: Healthscope Commercial |
$2,256.06
|
| Rate for Payer: Healthscope Whirlpool |
$2,325.84
|
| Rate for Payer: Mclaren Commercial |
$2,093.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,976.96
|
| Rate for Payer: Nomi Health Commercial |
$1,907.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,744.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,046.74
|
|
