|
HC MR LOWER EXTREM BIL ANY JOINT W CON
|
Facility
|
OP
|
$2,440.78
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Aetna Commercial |
$2,074.66
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,586.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$545.89
|
| Rate for Payer: BCN Commercial |
$545.89
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,952.62
|
| Rate for Payer: Cash Price |
$1,952.62
|
| Rate for Payer: Cofinity Advantage |
$1,708.55
|
| Rate for Payer: Cofinity Commercial |
$2,099.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,952.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,196.70
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,074.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,830.59
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$2,074.66
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,537.69
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,586.51
|
| Rate for Payer: UHC Core |
$1,271.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$959.23
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC MR LOWER EXTREM BIL ANY JOINT W CON
|
Facility
|
IP
|
$2,440.78
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,537.69 |
| Max. Negotiated Rate |
$2,196.70 |
| Rate for Payer: Aetna Commercial |
$2,074.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,586.51
|
| Rate for Payer: Cash Price |
$1,952.62
|
| Rate for Payer: Cofinity Advantage |
$1,708.55
|
| Rate for Payer: Cofinity Commercial |
$2,099.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,952.62
|
| Rate for Payer: Healthscope Commercial |
$2,196.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,074.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$2,074.66
|
| Rate for Payer: Priority Health SBD |
$1,537.69
|
|
|
HC MR LOWER EXTREM BILAT ANY JOINT WO CON
|
Facility
|
IP
|
$2,010.99
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,266.92 |
| Max. Negotiated Rate |
$1,809.89 |
| Rate for Payer: Aetna Commercial |
$1,709.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.14
|
| Rate for Payer: Cash Price |
$1,608.79
|
| Rate for Payer: Cofinity Advantage |
$1,407.69
|
| Rate for Payer: Cofinity Commercial |
$1,729.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.79
|
| Rate for Payer: Healthscope Commercial |
$1,809.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,709.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,508.24
|
| Rate for Payer: PHP Commercial |
$1,709.34
|
| Rate for Payer: Priority Health SBD |
$1,266.92
|
|
|
HC MR LOWER EXTREM BILAT ANY JOINT WO CON
|
Facility
|
OP
|
$2,010.99
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,809.89 |
| Rate for Payer: Aetna Commercial |
$1,709.34
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$324.05
|
| Rate for Payer: BCN Commercial |
$324.05
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,608.79
|
| Rate for Payer: Cash Price |
$1,608.79
|
| Rate for Payer: Cofinity Advantage |
$1,407.69
|
| Rate for Payer: Cofinity Commercial |
$1,729.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,809.89
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| 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 |
$249.63
|
| 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 |
$1,709.34
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,508.24
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,709.34
|
| 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/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,266.92
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.14
|
| Rate for Payer: UHC Core |
$1,047.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$790.32
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR LOWER EXTREM BIL NO JOINT W CON
|
Facility
|
OP
|
$3,014.98
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,713.48 |
| Rate for Payer: Aetna Commercial |
$2,562.73
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,959.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$432.32
|
| Rate for Payer: BCN Commercial |
$432.32
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cofinity Advantage |
$2,110.49
|
| Rate for Payer: Cofinity Commercial |
$2,592.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,411.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,713.48
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$2,562.73
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,261.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,562.73
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,899.44
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,959.74
|
| Rate for Payer: UHC Core |
$1,570.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,184.89
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR LOWER EXTREM BIL NO JOINT W CON
|
Facility
|
IP
|
$3,014.98
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,899.44 |
| Max. Negotiated Rate |
$2,713.48 |
| Rate for Payer: Aetna Commercial |
$2,562.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,959.74
|
| Rate for Payer: Cash Price |
$2,411.98
|
| Rate for Payer: Cofinity Advantage |
$2,110.49
|
| Rate for Payer: Cofinity Commercial |
$2,592.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,411.98
|
| Rate for Payer: Healthscope Commercial |
$2,713.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,562.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,261.24
|
| Rate for Payer: PHP Commercial |
$2,562.73
|
| Rate for Payer: Priority Health SBD |
$1,899.44
|
|
|
HC MR LOWER EXTREM BIL NO JOINT WO CON
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,476.12 |
| Max. Negotiated Rate |
$2,108.74 |
| Rate for Payer: Aetna Commercial |
$1,991.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.98
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Advantage |
$1,640.13
|
| Rate for Payer: Cofinity Commercial |
$2,015.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Healthscope Commercial |
$2,108.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: PHP Commercial |
$1,991.58
|
| Rate for Payer: Priority Health SBD |
$1,476.12
|
|
|
HC MR LOWER EXTREM BIL NO JOINT WO CON
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,108.74 |
| Rate for Payer: Aetna Commercial |
$1,991.58
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$368.73
|
| Rate for Payer: BCN Commercial |
$368.73
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Advantage |
$1,640.13
|
| Rate for Payer: Cofinity Commercial |
$2,015.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,108.74
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| 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 |
$249.63
|
| 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 |
$1,991.58
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,991.58
|
| 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/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,476.12
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,522.98
|
| Rate for Payer: UHC Core |
$1,220.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$920.81
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR LOWER EXTREM NO JOINT BIL WO W CON
|
Facility
|
IP
|
$3,221.72
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,029.68 |
| Max. Negotiated Rate |
$2,899.55 |
| Rate for Payer: Aetna Commercial |
$2,738.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,094.12
|
| Rate for Payer: Cash Price |
$2,577.38
|
| Rate for Payer: Cofinity Advantage |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$2,770.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,577.38
|
| Rate for Payer: Healthscope Commercial |
$2,899.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,738.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,416.29
|
| Rate for Payer: PHP Commercial |
$2,738.46
|
| Rate for Payer: Priority Health SBD |
$2,029.68
|
|
|
HC MR LOWER EXTREM NO JOINT BIL WO W CON
|
Facility
|
OP
|
$3,221.72
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,899.55 |
| Rate for Payer: Aetna Commercial |
$2,738.46
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,094.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$545.14
|
| Rate for Payer: BCN Commercial |
$545.14
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,577.38
|
| Rate for Payer: Cash Price |
$2,577.38
|
| Rate for Payer: Cofinity Advantage |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$2,770.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,577.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,899.55
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$2,738.46
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,416.29
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,738.46
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,029.68
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,094.12
|
| Rate for Payer: UHC Core |
$1,678.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,266.14
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR LOWER EXTREM NO JOINT W CON
|
Facility
|
IP
|
$2,412.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000031
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,519.56 |
| Max. Negotiated Rate |
$2,170.80 |
| Rate for Payer: Aetna Commercial |
$2,050.20
|
| Rate for Payer: Aetna Commercial |
$3,075.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,567.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,351.71
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$2,894.41
|
| Rate for Payer: Cofinity Advantage |
$1,688.40
|
| Rate for Payer: Cofinity Advantage |
$2,532.61
|
| Rate for Payer: Cofinity Commercial |
$2,074.32
|
| Rate for Payer: Cofinity Commercial |
$3,111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.60
|
| Rate for Payer: Healthscope Commercial |
$3,256.21
|
| Rate for Payer: Healthscope Commercial |
$2,170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,713.51
|
| Rate for Payer: PHP Commercial |
$2,050.20
|
| Rate for Payer: PHP Commercial |
$3,075.31
|
| Rate for Payer: Priority Health SBD |
$1,519.56
|
| Rate for Payer: Priority Health SBD |
$2,279.35
|
|
|
HC MR LOWER EXTREM NO JOINT W CON
|
Facility
|
OP
|
$2,412.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
61000031
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,170.80 |
| Rate for Payer: Aetna Commercial |
$2,050.20
|
| Rate for Payer: Aetna Commercial |
$3,075.31
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,351.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,567.80
|
| 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: 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 |
$432.32
|
| Rate for Payer: BCBS Trust/PPO |
$432.32
|
| Rate for Payer: BCN Commercial |
$432.32
|
| Rate for Payer: BCN Commercial |
$432.32
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$2,894.41
|
| Rate for Payer: Cash Price |
$2,894.41
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cofinity Advantage |
$2,532.61
|
| Rate for Payer: Cofinity Advantage |
$1,688.40
|
| Rate for Payer: Cofinity Commercial |
$3,111.49
|
| Rate for Payer: Cofinity Commercial |
$2,074.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,894.41
|
| 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 |
$2,170.80
|
| Rate for Payer: Healthscope Commercial |
$3,256.21
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| 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 |
$2,050.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.31
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,713.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.00
|
| 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 |
$3,075.31
|
| Rate for Payer: PHP Commercial |
$2,050.20
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,279.35
|
| Rate for Payer: Priority Health SBD |
$1,519.56
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,567.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,351.71
|
| Rate for Payer: UHC Core |
$1,884.98
|
| Rate for Payer: UHC Core |
$1,256.65
|
| 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 |
$1,421.88
|
| Rate for Payer: UHC Exchange |
$947.92
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| 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 LOWER EXTREM NO JOINT WO CON
|
Facility
|
IP
|
$2,175.58
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,370.62 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: Aetna Commercial |
$2,773.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,121.19
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cash Price |
$2,610.70
|
| Rate for Payer: Cofinity Advantage |
$1,522.91
|
| Rate for Payer: Cofinity Advantage |
$2,284.36
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Cofinity Commercial |
$2,806.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,610.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$2,937.03
|
| Rate for Payer: Healthscope Commercial |
$1,958.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,773.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,631.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,447.53
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| Rate for Payer: PHP Commercial |
$2,773.86
|
| Rate for Payer: Priority Health SBD |
$1,370.62
|
| Rate for Payer: Priority Health SBD |
$2,055.92
|
|
|
HC MR LOWER EXTREM NO JOINT WO CON
|
Facility
|
OP
|
$2,175.58
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,958.02 |
| Rate for Payer: Aetna Commercial |
$1,849.24
|
| Rate for Payer: Aetna Commercial |
$2,773.86
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,121.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.13
|
| 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: 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 |
$368.73
|
| Rate for Payer: BCBS Trust/PPO |
$368.73
|
| Rate for Payer: BCN Commercial |
$368.73
|
| Rate for Payer: BCN Commercial |
$368.73
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cash Price |
$2,610.70
|
| Rate for Payer: Cash Price |
$2,610.70
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Advantage |
$2,284.36
|
| Rate for Payer: Cofinity Advantage |
$1,522.91
|
| Rate for Payer: Cofinity Commercial |
$2,806.50
|
| Rate for Payer: Cofinity Commercial |
$1,871.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,610.70
|
| 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 |
$1,958.02
|
| Rate for Payer: Healthscope Commercial |
$2,937.03
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| 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 |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| 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 |
$1,849.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,773.86
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,447.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,631.68
|
| 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 |
$2,773.86
|
| Rate for Payer: PHP Commercial |
$1,849.24
|
| 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/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$2,055.92
|
| Rate for Payer: Priority Health SBD |
$1,370.62
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,414.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,121.19
|
| Rate for Payer: UHC Core |
$1,700.22
|
| Rate for Payer: UHC Core |
$1,133.48
|
| 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 |
$1,282.50
|
| Rate for Payer: UHC Exchange |
$855.00
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| 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 LOWER EXTREM NO JOINT WO W CON
|
Facility
|
IP
|
$3,090.29
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
61000033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,946.88 |
| Max. Negotiated Rate |
$2,781.26 |
| Rate for Payer: Aetna Commercial |
$2,626.75
|
| Rate for Payer: Aetna Commercial |
$3,940.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,013.04
|
| Rate for Payer: Cash Price |
$2,472.23
|
| Rate for Payer: Cash Price |
$3,708.35
|
| Rate for Payer: Cofinity Advantage |
$2,163.20
|
| Rate for Payer: Cofinity Advantage |
$3,244.81
|
| Rate for Payer: Cofinity Commercial |
$2,657.65
|
| Rate for Payer: Cofinity Commercial |
$3,986.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,708.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.23
|
| Rate for Payer: Healthscope Commercial |
$4,171.90
|
| Rate for Payer: Healthscope Commercial |
$2,781.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,940.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,317.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,476.58
|
| Rate for Payer: PHP Commercial |
$2,626.75
|
| Rate for Payer: PHP Commercial |
$3,940.12
|
| Rate for Payer: Priority Health SBD |
$1,946.88
|
| Rate for Payer: Priority Health SBD |
$2,920.33
|
|
|
HC MR LOWER EXTREM NO JOINT WO W CON
|
Facility
|
OP
|
$3,090.29
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
61000033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,781.26 |
| Rate for Payer: Aetna Commercial |
$2,626.75
|
| Rate for Payer: Aetna Commercial |
$3,940.12
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,013.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.69
|
| 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: 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 |
$545.14
|
| Rate for Payer: BCBS Trust/PPO |
$545.14
|
| Rate for Payer: BCN Commercial |
$545.14
|
| Rate for Payer: BCN Commercial |
$545.14
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,472.23
|
| Rate for Payer: Cash Price |
$3,708.35
|
| Rate for Payer: Cash Price |
$3,708.35
|
| Rate for Payer: Cash Price |
$2,472.23
|
| Rate for Payer: Cofinity Advantage |
$3,244.81
|
| Rate for Payer: Cofinity Advantage |
$2,163.20
|
| Rate for Payer: Cofinity Commercial |
$3,986.48
|
| Rate for Payer: Cofinity Commercial |
$2,657.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,708.35
|
| 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 |
$2,781.26
|
| Rate for Payer: Healthscope Commercial |
$4,171.90
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| 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 |
$2,626.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,940.12
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,476.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,317.72
|
| 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 |
$3,940.12
|
| Rate for Payer: PHP Commercial |
$2,626.75
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,920.33
|
| Rate for Payer: Priority Health SBD |
$1,946.88
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,008.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,013.04
|
| Rate for Payer: UHC Core |
$2,415.06
|
| Rate for Payer: UHC Core |
$1,610.04
|
| 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 |
$1,821.73
|
| Rate for Payer: UHC Exchange |
$1,214.48
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| 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 MRA ABDOMEN W CON
|
Facility
|
OP
|
$2,297.10
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
61000060
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Advantage |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,722.83
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,493.12
|
| Rate for Payer: UHC Core |
$1,196.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$902.76
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR MRA ABDOMEN W CON
|
Facility
|
IP
|
$2,297.10
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
61000060
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,447.17 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Advantage |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,722.83
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
|
|
HC MR MRA ABDOMEN WO CON
|
Facility
|
OP
|
$2,153.63
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000061
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Advantage |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| 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 |
$249.63
|
| 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 |
$1,830.59
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.22
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| 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/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,399.86
|
| Rate for Payer: UHC Core |
$1,122.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$846.38
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR MRA ABDOMEN WO CON
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000061
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,356.79 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Advantage |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.22
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
|
|
HC MR MRA ABDOMEN WO W CON
|
Facility
|
OP
|
$2,782.39
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
61000062
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,504.15 |
| Rate for Payer: Aetna Commercial |
$2,365.03
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,225.91
|
| Rate for Payer: Cash Price |
$2,225.91
|
| Rate for Payer: Cofinity Advantage |
$1,947.67
|
| Rate for Payer: Cofinity Commercial |
$2,392.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,225.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,504.15
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$2,365.03
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,086.79
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,365.03
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,752.91
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,808.55
|
| Rate for Payer: UHC Core |
$1,449.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,093.48
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR MRA ABDOMEN WO W CON
|
Facility
|
IP
|
$2,782.39
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
61000062
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,752.91 |
| Max. Negotiated Rate |
$2,504.15 |
| Rate for Payer: Aetna Commercial |
$2,365.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.55
|
| Rate for Payer: Cash Price |
$2,225.91
|
| Rate for Payer: Cofinity Advantage |
$1,947.67
|
| Rate for Payer: Cofinity Commercial |
$2,392.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,225.91
|
| Rate for Payer: Healthscope Commercial |
$2,504.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,365.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,086.79
|
| Rate for Payer: PHP Commercial |
$2,365.03
|
| Rate for Payer: Priority Health SBD |
$1,752.91
|
|
|
HC MR MRA CHEST W CON
|
Facility
|
IP
|
$2,297.10
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
61000063
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,447.17 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Advantage |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,722.83
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
|
|
HC MR MRA CHEST W CON
|
Facility
|
OP
|
$2,297.10
|
|
|
Service Code
|
HCPCS C8909
|
| Hospital Charge Code |
61000063
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Advantage |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,722.83
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,493.12
|
| Rate for Payer: UHC Core |
$1,196.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$902.76
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR MRA CHEST WO CON
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
HCPCS C8910
|
| Hospital Charge Code |
61000064
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,356.79 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Advantage |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.22
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
|
