|
HC MR SPINE THORACIC WO LIMITED
|
Facility
|
IP
|
$725.33
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
61200005
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$456.96 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Aetna Commercial |
$616.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.46
|
| Rate for Payer: Cash Price |
$580.26
|
| Rate for Payer: Cofinity Advantage |
$507.73
|
| Rate for Payer: Cofinity Commercial |
$623.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$580.26
|
| Rate for Payer: Healthscope Commercial |
$652.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.00
|
| Rate for Payer: PHP Commercial |
$616.53
|
| Rate for Payer: Priority Health SBD |
$456.96
|
|
|
HC MR SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,692.61
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,696.34 |
| Max. Negotiated Rate |
$2,423.35 |
| Rate for Payer: Aetna Commercial |
$2,288.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,750.20
|
| Rate for Payer: Cash Price |
$2,154.09
|
| Rate for Payer: Cofinity Advantage |
$1,884.83
|
| Rate for Payer: Cofinity Commercial |
$2,315.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,154.09
|
| Rate for Payer: Healthscope Commercial |
$2,423.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,288.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,019.46
|
| Rate for Payer: PHP Commercial |
$2,288.72
|
| Rate for Payer: Priority Health SBD |
$1,696.34
|
|
|
HC MR SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,692.61
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,423.35 |
| Rate for Payer: Aetna Commercial |
$2,288.72
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,750.20
|
| 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 |
$492.90
|
| Rate for Payer: BCN Commercial |
$492.90
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,154.09
|
| Rate for Payer: Cash Price |
$2,154.09
|
| Rate for Payer: Cofinity Advantage |
$1,884.83
|
| Rate for Payer: Cofinity Commercial |
$2,315.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,154.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,423.35
|
| 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 |
$2,288.72
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,019.46
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,288.72
|
| 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 |
$1,696.34
|
| 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) |
$1,750.20
|
| Rate for Payer: UHC Core |
$1,402.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,058.20
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR SPINE THORACIC WO W LTD
|
Facility
|
OP
|
$942.99
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,124.16 |
| Rate for Payer: Aetna Commercial |
$801.54
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.94
|
| 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 |
$492.90
|
| Rate for Payer: BCN Commercial |
$492.90
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Cofinity Advantage |
$660.09
|
| Rate for Payer: Cofinity Commercial |
$810.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$848.69
|
| 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 |
$801.54
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$801.54
|
| 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 |
$594.08
|
| 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) |
$612.94
|
| Rate for Payer: UHC Core |
$491.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$370.60
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR SPINE THORACIC WO W LTD
|
Facility
|
IP
|
$942.99
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$594.08 |
| Max. Negotiated Rate |
$848.69 |
| Rate for Payer: Aetna Commercial |
$801.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.94
|
| Rate for Payer: Cash Price |
$754.39
|
| Rate for Payer: Cofinity Advantage |
$660.09
|
| Rate for Payer: Cofinity Commercial |
$810.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.39
|
| Rate for Payer: Healthscope Commercial |
$848.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.24
|
| Rate for Payer: PHP Commercial |
$801.54
|
| Rate for Payer: Priority Health SBD |
$594.08
|
|
|
HC MR TEMPOROMANDIBULAR JTS
|
Facility
|
IP
|
$2,114.36
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,332.05 |
| Max. Negotiated Rate |
$1,902.92 |
| Rate for Payer: Aetna Commercial |
$1,797.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.33
|
| Rate for Payer: Cash Price |
$1,691.49
|
| Rate for Payer: Cofinity Advantage |
$1,480.05
|
| Rate for Payer: Cofinity Commercial |
$1,818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.49
|
| Rate for Payer: Healthscope Commercial |
$1,902.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,585.77
|
| Rate for Payer: PHP Commercial |
$1,797.21
|
| Rate for Payer: Priority Health SBD |
$1,332.05
|
|
|
HC MR TEMPOROMANDIBULAR JTS
|
Facility
|
OP
|
$2,114.36
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,902.92 |
| Rate for Payer: Aetna Commercial |
$1,797.21
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.33
|
| 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 |
$446.71
|
| Rate for Payer: BCN Commercial |
$446.71
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,691.49
|
| Rate for Payer: Cash Price |
$1,691.49
|
| Rate for Payer: Cofinity Advantage |
$1,480.05
|
| Rate for Payer: Cofinity Commercial |
$1,818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,902.92
|
| 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 |
$1,797.21
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,585.77
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,797.21
|
| 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 |
$1,332.05
|
| 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) |
$1,374.33
|
| Rate for Payer: UHC Core |
$1,101.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$830.94
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR UPPER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
OP
|
$2,635.94
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Aetna Commercial |
$2,240.55
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,713.36
|
| 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 |
$654.93
|
| Rate for Payer: BCN Commercial |
$654.93
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Advantage |
$1,845.16
|
| Rate for Payer: Cofinity Commercial |
$2,266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,372.35
|
| 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 |
$2,240.55
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,240.55
|
| 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 |
$1,660.64
|
| 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) |
$1,713.36
|
| Rate for Payer: UHC Core |
$1,373.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,035.92
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
IP
|
$2,635.94
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,660.64 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Aetna Commercial |
$2,240.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,713.36
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Advantage |
$1,845.16
|
| Rate for Payer: Cofinity Commercial |
$2,266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Healthscope Commercial |
$2,372.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,240.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: PHP Commercial |
$2,240.55
|
| Rate for Payer: Priority Health SBD |
$1,660.64
|
|
|
HC MR UPPER EXTREM ANY JOINT W CON
|
Facility
|
IP
|
$2,336.68
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,472.11 |
| Max. Negotiated Rate |
$2,103.01 |
| Rate for Payer: Aetna Commercial |
$1,986.18
|
| Rate for Payer: Aetna Commercial |
$2,979.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,278.27
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cofinity Advantage |
$1,635.68
|
| Rate for Payer: Cofinity Advantage |
$2,453.52
|
| Rate for Payer: Cofinity Commercial |
$2,009.54
|
| Rate for Payer: Cofinity Commercial |
$3,014.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Healthscope Commercial |
$3,154.53
|
| Rate for Payer: Healthscope Commercial |
$2,103.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: PHP Commercial |
$1,986.18
|
| Rate for Payer: PHP Commercial |
$2,979.28
|
| Rate for Payer: Priority Health SBD |
$1,472.11
|
| Rate for Payer: Priority Health SBD |
$2,208.17
|
|
|
HC MR UPPER EXTREM ANY JOINT W CON
|
Facility
|
OP
|
$2,336.68
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,986.18
|
| Rate for Payer: Aetna Commercial |
$2,979.28
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,278.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$542.11
|
| Rate for Payer: BCBS Trust/PPO |
$542.11
|
| Rate for Payer: BCN Commercial |
$542.11
|
| Rate for Payer: BCN Commercial |
$542.11
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cofinity Advantage |
$2,453.52
|
| Rate for Payer: Cofinity Advantage |
$1,635.68
|
| Rate for Payer: Cofinity Commercial |
$3,014.33
|
| Rate for Payer: Cofinity Commercial |
$2,009.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,103.01
|
| Rate for Payer: Healthscope Commercial |
$3,154.53
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$2,979.28
|
| Rate for Payer: PHP Commercial |
$1,986.18
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$2,208.17
|
| Rate for Payer: Priority Health SBD |
$1,472.11
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,518.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,278.27
|
| Rate for Payer: UHC Core |
$1,826.12
|
| Rate for Payer: UHC Core |
$1,217.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,377.48
|
| Rate for Payer: UHC Exchange |
$918.32
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC MR UPPER EXTREM ANY JOINT WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,282.13 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Commercial |
$2,594.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.25
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cofinity Advantage |
$1,424.58
|
| Rate for Payer: Cofinity Advantage |
$2,136.88
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Commercial |
$2,625.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$2,747.42
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Commercial |
$2,594.79
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| Rate for Payer: Priority Health SBD |
$1,923.19
|
|
|
HC MR UPPER EXTREM ANY JOINT WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Commercial |
$2,594.79
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| 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 |
$324.82
|
| Rate for Payer: BCBS Trust/PPO |
$324.82
|
| Rate for Payer: BCN Commercial |
$324.82
|
| Rate for Payer: BCN Commercial |
$324.82
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Advantage |
$2,136.88
|
| Rate for Payer: Cofinity Advantage |
$1,424.58
|
| Rate for Payer: Cofinity Commercial |
$2,625.31
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| 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 |
$1,831.61
|
| Rate for Payer: Healthscope Commercial |
$2,747.42
|
| 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 |
$1,729.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| 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 |
$2,594.79
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| 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 |
$1,923.19
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| 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) |
$1,322.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,984.25
|
| Rate for Payer: UHC Core |
$1,590.45
|
| Rate for Payer: UHC Core |
$1,060.30
|
| 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 |
$1,199.71
|
| Rate for Payer: UHC Exchange |
$799.80
|
| 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 UPPER EXTREM ANY JOINT WO W CON
|
Facility
|
IP
|
$2,508.56
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,580.39 |
| Max. Negotiated Rate |
$2,257.70 |
| Rate for Payer: Aetna Commercial |
$2,132.28
|
| Rate for Payer: Aetna Commercial |
$3,198.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,445.84
|
| Rate for Payer: Cash Price |
$2,006.85
|
| Rate for Payer: Cash Price |
$3,010.26
|
| Rate for Payer: Cofinity Advantage |
$1,755.99
|
| Rate for Payer: Cofinity Advantage |
$2,633.98
|
| Rate for Payer: Cofinity Commercial |
$2,157.36
|
| Rate for Payer: Cofinity Commercial |
$3,236.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.85
|
| Rate for Payer: Healthscope Commercial |
$3,386.55
|
| Rate for Payer: Healthscope Commercial |
$2,257.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,881.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,822.12
|
| Rate for Payer: PHP Commercial |
$2,132.28
|
| Rate for Payer: PHP Commercial |
$3,198.41
|
| Rate for Payer: Priority Health SBD |
$1,580.39
|
| Rate for Payer: Priority Health SBD |
$2,370.58
|
|
|
HC MR UPPER EXTREM ANY JOINT WO W CON
|
Facility
|
OP
|
$2,508.56
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,257.70 |
| Rate for Payer: Aetna Commercial |
$2,132.28
|
| Rate for Payer: Aetna Commercial |
$3,198.41
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,445.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.56
|
| 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 |
$654.93
|
| Rate for Payer: BCBS Trust/PPO |
$654.93
|
| Rate for Payer: BCN Commercial |
$654.93
|
| Rate for Payer: BCN Commercial |
$654.93
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,006.85
|
| Rate for Payer: Cash Price |
$3,010.26
|
| Rate for Payer: Cash Price |
$3,010.26
|
| Rate for Payer: Cash Price |
$2,006.85
|
| Rate for Payer: Cofinity Advantage |
$2,633.98
|
| Rate for Payer: Cofinity Advantage |
$1,755.99
|
| Rate for Payer: Cofinity Commercial |
$3,236.03
|
| Rate for Payer: Cofinity Commercial |
$2,157.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.26
|
| 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 |
$2,257.70
|
| Rate for Payer: Healthscope Commercial |
$3,386.55
|
| 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 |
$2,132.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.41
|
| 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 |
$2,822.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,881.42
|
| 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 |
$3,198.41
|
| Rate for Payer: PHP Commercial |
$2,132.28
|
| 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 |
$2,370.58
|
| Rate for Payer: Priority Health SBD |
$1,580.39
|
| 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) |
$1,630.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,445.84
|
| Rate for Payer: UHC Core |
$1,960.43
|
| Rate for Payer: UHC Core |
$1,306.96
|
| 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 |
$1,478.79
|
| Rate for Payer: UHC Exchange |
$985.86
|
| 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 UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
OP
|
$2,562.71
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$2,178.30
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.76
|
| 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 |
$542.11
|
| Rate for Payer: BCN Commercial |
$542.11
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cofinity Advantage |
$1,793.90
|
| Rate for Payer: Cofinity Commercial |
$2,203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,306.44
|
| 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 |
$2,178.30
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.03
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$2,178.30
|
| 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 |
$1,614.51
|
| 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) |
$1,665.76
|
| Rate for Payer: UHC Core |
$1,335.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,007.15
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
IP
|
$2,562.71
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,614.51 |
| Max. Negotiated Rate |
$2,306.44 |
| Rate for Payer: Aetna Commercial |
$2,178.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.76
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cofinity Advantage |
$1,793.90
|
| Rate for Payer: Cofinity Commercial |
$2,203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.17
|
| Rate for Payer: Healthscope Commercial |
$2,306.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.03
|
| Rate for Payer: PHP Commercial |
$2,178.30
|
| Rate for Payer: Priority Health SBD |
$1,614.51
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
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 |
$324.82
|
| Rate for Payer: BCN Commercial |
$324.82
|
| 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 UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
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 UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
IP
|
$2,512.46
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,582.85 |
| Max. Negotiated Rate |
$2,261.21 |
| Rate for Payer: Aetna Commercial |
$2,135.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,633.10
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cofinity Advantage |
$1,758.72
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.97
|
| Rate for Payer: Healthscope Commercial |
$2,261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,135.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,884.35
|
| Rate for Payer: PHP Commercial |
$2,135.59
|
| Rate for Payer: Priority Health SBD |
$1,582.85
|
|
|
HC MR UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
OP
|
$2,512.46
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,261.21 |
| Rate for Payer: Aetna Commercial |
$2,135.59
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,633.10
|
| 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 |
$586.79
|
| Rate for Payer: BCN Commercial |
$586.79
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cofinity Advantage |
$1,758.72
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,261.21
|
| 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 |
$2,135.59
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,884.35
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,135.59
|
| 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 |
$1,582.85
|
| 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) |
$1,633.10
|
| Rate for Payer: UHC Core |
$1,308.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$987.40
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
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 UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
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 |
$548.94
|
| Rate for Payer: BCN Commercial |
$548.94
|
| 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 UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
IP
|
$2,635.94
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,660.64 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Aetna Commercial |
$2,240.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,713.36
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Advantage |
$1,845.16
|
| Rate for Payer: Cofinity Commercial |
$2,266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Healthscope Commercial |
$2,372.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,240.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: PHP Commercial |
$2,240.55
|
| Rate for Payer: Priority Health SBD |
$1,660.64
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
OP
|
$2,635.94
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Aetna Commercial |
$2,240.55
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,713.36
|
| 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 |
$710.20
|
| Rate for Payer: BCN Commercial |
$710.20
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Advantage |
$1,845.16
|
| Rate for Payer: Cofinity Commercial |
$2,266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,372.35
|
| 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 |
$2,240.55
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,240.55
|
| 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 |
$1,660.64
|
| 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) |
$1,713.36
|
| Rate for Payer: UHC Core |
$1,373.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,035.92
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
