|
HC MR MRCP
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,110.45 |
| Rate for Payer: Aetna Commercial |
$1,899.40
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$2,047.14
|
| Rate for Payer: ASR Commercial |
$2,047.14
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.25
|
| Rate for Payer: BCN Commercial |
$1,636.23
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,983.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,110.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,047.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,899.40
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$1,730.57
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.18
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.43
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,857.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$1,005.41 |
| Rate for Payer: Aetna Commercial |
$904.87
|
| Rate for Payer: Aetna Medicare |
$502.70
|
| Rate for Payer: ASR ASR |
$975.25
|
| Rate for Payer: ASR Commercial |
$975.25
|
| Rate for Payer: BCBS Complete |
$402.16
|
| Rate for Payer: BCBS Trust/PPO |
$823.33
|
| Rate for Payer: BCN Commercial |
$779.49
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$945.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$1,005.41
|
| Rate for Payer: Healthscope Whirlpool |
$975.25
|
| Rate for Payer: Mclaren Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: Nomi Health Commercial |
$824.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$880.94
|
| Rate for Payer: Priority Health Narrow Network |
$704.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$884.76
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$653.52 |
| Max. Negotiated Rate |
$1,005.41 |
| Rate for Payer: Aetna Commercial |
$904.87
|
| Rate for Payer: ASR ASR |
$975.25
|
| Rate for Payer: ASR Commercial |
$975.25
|
| Rate for Payer: BCBS Trust/PPO |
$819.31
|
| Rate for Payer: BCN Commercial |
$779.49
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$945.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$1,005.41
|
| Rate for Payer: Healthscope Whirlpool |
$975.25
|
| Rate for Payer: Mclaren Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: Nomi Health Commercial |
$824.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$884.76
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,441.03 |
| Max. Negotiated Rate |
$2,216.97 |
| Rate for Payer: Aetna Commercial |
$1,995.27
|
| Rate for Payer: ASR ASR |
$2,150.46
|
| Rate for Payer: ASR Commercial |
$2,150.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,806.61
|
| Rate for Payer: BCN Commercial |
$1,718.82
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$2,083.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Healthscope Commercial |
$2,216.97
|
| Rate for Payer: Healthscope Whirlpool |
$2,150.46
|
| Rate for Payer: Mclaren Commercial |
$1,995.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: Nomi Health Commercial |
$1,817.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,950.93
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,216.97 |
| Rate for Payer: Aetna Commercial |
$1,995.27
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,150.46
|
| Rate for Payer: ASR Commercial |
$2,150.46
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.48
|
| Rate for Payer: BCN Commercial |
$1,718.82
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$2,083.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,216.97
|
| Rate for Payer: Healthscope Whirlpool |
$2,150.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$1,995.27
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: Nomi Health Commercial |
$1,817.92
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,942.51
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,554.10
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,950.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,146.49 |
| Rate for Payer: Aetna Commercial |
$1,931.84
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,082.10
|
| Rate for Payer: ASR Commercial |
$2,082.10
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.76
|
| Rate for Payer: BCN Commercial |
$1,664.17
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$2,017.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,146.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$1,931.84
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.75
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,504.69
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,888.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,395.22 |
| Max. Negotiated Rate |
$2,146.49 |
| Rate for Payer: Aetna Commercial |
$1,931.84
|
| Rate for Payer: ASR ASR |
$2,082.10
|
| Rate for Payer: ASR Commercial |
$2,082.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.17
|
| Rate for Payer: BCN Commercial |
$1,664.17
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$2,017.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Healthscope Commercial |
$2,146.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.10
|
| Rate for Payer: Mclaren Commercial |
$1,931.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: Nomi Health Commercial |
$1,760.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,888.91
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,322.83 |
| Max. Negotiated Rate |
$2,035.12 |
| Rate for Payer: Aetna Commercial |
$1,831.61
|
| Rate for Payer: ASR ASR |
$1,974.07
|
| Rate for Payer: ASR Commercial |
$1,974.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.42
|
| Rate for Payer: BCN Commercial |
$1,577.83
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,913.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$2,035.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,974.07
|
| Rate for Payer: Mclaren Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.91
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,035.12 |
| Rate for Payer: Aetna Commercial |
$1,831.61
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,974.07
|
| Rate for Payer: ASR Commercial |
$1,974.07
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,666.56
|
| Rate for Payer: BCN Commercial |
$1,577.83
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,913.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,035.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,974.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,831.61
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,783.17
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.62
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,788.74 |
| Rate for Payer: Aetna Commercial |
$2,509.87
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,705.08
|
| Rate for Payer: ASR Commercial |
$2,705.08
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.70
|
| Rate for Payer: BCN Commercial |
$2,162.11
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,621.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,788.74
|
| Rate for Payer: Healthscope Whirlpool |
$2,705.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,509.87
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,443.49
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,954.91
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,454.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,812.68 |
| Max. Negotiated Rate |
$2,788.74 |
| Rate for Payer: Aetna Commercial |
$2,509.87
|
| Rate for Payer: ASR ASR |
$2,705.08
|
| Rate for Payer: ASR Commercial |
$2,705.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.54
|
| Rate for Payer: BCN Commercial |
$2,162.11
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,621.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Healthscope Commercial |
$2,788.74
|
| Rate for Payer: Healthscope Whirlpool |
$2,705.08
|
| Rate for Payer: Mclaren Commercial |
$2,509.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: Nomi Health Commercial |
$2,286.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,454.09
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,243.18 |
| Rate for Payer: Aetna Commercial |
$2,018.86
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,175.88
|
| Rate for Payer: ASR Commercial |
$2,175.88
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.94
|
| Rate for Payer: BCN Commercial |
$1,739.14
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$2,108.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,243.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,175.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,018.86
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,965.47
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,572.47
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,458.07 |
| Max. Negotiated Rate |
$2,243.18 |
| Rate for Payer: Aetna Commercial |
$2,018.86
|
| Rate for Payer: ASR ASR |
$2,175.88
|
| Rate for Payer: ASR Commercial |
$2,175.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.97
|
| Rate for Payer: BCN Commercial |
$1,739.14
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$2,108.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,243.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,175.88
|
| Rate for Payer: Mclaren Commercial |
$2,018.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.00
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,321.28 |
| Max. Negotiated Rate |
$2,032.74 |
| Rate for Payer: Aetna Commercial |
$1,829.47
|
| Rate for Payer: ASR ASR |
$1,971.76
|
| Rate for Payer: ASR Commercial |
$1,971.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.48
|
| Rate for Payer: BCN Commercial |
$1,575.98
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,910.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Healthscope Commercial |
$2,032.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.76
|
| Rate for Payer: Mclaren Commercial |
$1,829.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.81
|
|
|
HC MR PELVIS WO CON
|
Facility
|
OP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,032.74 |
| Rate for Payer: Aetna Commercial |
$1,829.47
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$1,971.76
|
| Rate for Payer: ASR Commercial |
$1,971.76
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.61
|
| Rate for Payer: BCN Commercial |
$1,575.98
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,910.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,032.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$1,829.47
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: Nomi Health Commercial |
$1,666.85
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,781.09
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.95
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
OP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,049.16 |
| Rate for Payer: Aetna Commercial |
$2,744.24
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,957.69
|
| Rate for Payer: ASR Commercial |
$2,957.69
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,496.96
|
| Rate for Payer: BCN Commercial |
$2,364.01
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,049.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,957.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,744.24
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,671.67
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,137.46
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,683.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR PELVIS WO W CON
|
Facility
|
IP
|
$3,049.16
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,981.95 |
| Max. Negotiated Rate |
$3,049.16 |
| Rate for Payer: Aetna Commercial |
$2,744.24
|
| Rate for Payer: ASR ASR |
$2,957.69
|
| Rate for Payer: ASR Commercial |
$2,957.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,484.76
|
| Rate for Payer: BCN Commercial |
$2,364.01
|
| Rate for Payer: Cash Price |
$2,439.33
|
| Rate for Payer: Cofinity Commercial |
$2,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,439.33
|
| Rate for Payer: Healthscope Commercial |
$3,049.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,957.69
|
| Rate for Payer: Mclaren Commercial |
$2,744.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.79
|
| Rate for Payer: Nomi Health Commercial |
$2,500.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,683.26
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
IP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,235.10 |
| Max. Negotiated Rate |
$1,900.16 |
| Rate for Payer: Aetna Commercial |
$1,710.14
|
| Rate for Payer: ASR ASR |
$1,843.16
|
| Rate for Payer: ASR Commercial |
$1,843.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.44
|
| Rate for Payer: BCN Commercial |
$1,473.19
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,786.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Healthscope Commercial |
$1,900.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,843.16
|
| Rate for Payer: Mclaren Commercial |
$1,710.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,672.14
|
|
|
HC MR SPECTROSCOPY
|
Facility
|
OP
|
$1,900.16
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$1,900.16 |
| Rate for Payer: Aetna Commercial |
$1,710.14
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$1,843.16
|
| Rate for Payer: ASR Commercial |
$1,843.16
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,556.04
|
| Rate for Payer: BCN Commercial |
$1,473.19
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cash Price |
$1,520.13
|
| Rate for Payer: Cofinity Commercial |
$1,786.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$1,900.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,843.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$1,710.14
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.14
|
| Rate for Payer: Nomi Health Commercial |
$1,558.13
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,664.92
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,332.01
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,672.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
IP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,509.52 |
| Max. Negotiated Rate |
$2,322.34 |
| Rate for Payer: Aetna Commercial |
$2,090.11
|
| Rate for Payer: ASR ASR |
$2,252.67
|
| Rate for Payer: ASR Commercial |
$2,252.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,892.47
|
| Rate for Payer: BCN Commercial |
$1,800.51
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$2,183.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Healthscope Commercial |
$2,322.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,252.67
|
| Rate for Payer: Mclaren Commercial |
$2,090.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,043.66
|
|
|
HC MR SPINE CERVICAL W CON
|
Facility
|
OP
|
$2,322.34
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200004
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,322.34 |
| Rate for Payer: Aetna Commercial |
$2,090.11
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,252.67
|
| Rate for Payer: ASR Commercial |
$2,252.67
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.76
|
| Rate for Payer: BCN Commercial |
$1,800.51
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cash Price |
$1,857.87
|
| Rate for Payer: Cofinity Commercial |
$2,183.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,322.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,252.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,090.11
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,973.99
|
| Rate for Payer: Nomi Health Commercial |
$1,904.32
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,034.83
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,627.96
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,043.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
OP
|
$1,160.76
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,160.76 |
| Rate for Payer: Aetna Commercial |
$1,044.68
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$1,125.94
|
| Rate for Payer: ASR Commercial |
$1,125.94
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$950.55
|
| Rate for Payer: BCN Commercial |
$899.94
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$1,091.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,160.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$1,044.68
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: Nomi Health Commercial |
$951.82
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.06
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$813.69
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,021.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR SPINE CERVICAL W CON LTD
|
Facility
|
IP
|
$1,160.76
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
61200003
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$754.49 |
| Max. Negotiated Rate |
$1,160.76 |
| Rate for Payer: Aetna Commercial |
$1,044.68
|
| Rate for Payer: ASR ASR |
$1,125.94
|
| Rate for Payer: ASR Commercial |
$1,125.94
|
| Rate for Payer: BCBS Trust/PPO |
$945.90
|
| Rate for Payer: BCN Commercial |
$899.94
|
| Rate for Payer: Cash Price |
$928.61
|
| Rate for Payer: Cofinity Commercial |
$1,091.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.61
|
| Rate for Payer: Healthscope Commercial |
$1,160.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.94
|
| Rate for Payer: Mclaren Commercial |
$1,044.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.65
|
| Rate for Payer: Nomi Health Commercial |
$951.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,021.47
|
|
|
HC MR SPINE CERVICAL WO CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,487.23 |
| Max. Negotiated Rate |
$2,288.04 |
| Rate for Payer: Aetna Commercial |
$2,059.24
|
| Rate for Payer: ASR ASR |
$2,219.40
|
| Rate for Payer: ASR Commercial |
$2,219.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.52
|
| Rate for Payer: BCN Commercial |
$1,773.92
|
| 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 |
$2,288.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,219.40
|
| 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: Priority Health Cigna Priority Health |
$1,487.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,013.48
|
|
|
HC MR SPINE CERVICAL WO CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
61200002
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,288.04 |
| Rate for Payer: Aetna Commercial |
$2,059.24
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$2,219.40
|
| Rate for Payer: ASR Commercial |
$2,219.40
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,873.68
|
| Rate for Payer: BCN Commercial |
$1,773.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| 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 |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,288.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,219.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$2,059.24
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,004.78
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,603.92
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,013.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
