|
HC MR MRA UPPER EXTREMITY BIL W CO
|
Facility
|
IP
|
$2,122.52
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
61000075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,337.19 |
| Max. Negotiated Rate |
$1,910.27 |
| Rate for Payer: Aetna Commercial |
$1,804.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.64
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cofinity Commercial |
$1,485.76
|
| Rate for Payer: Cofinity Commercial |
$1,825.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,485.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.02
|
| Rate for Payer: Healthscope Commercial |
$1,910.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,804.14
|
| Rate for Payer: PHP Commercial |
$1,804.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.64
|
| Rate for Payer: Priority Health SBD |
$1,337.19
|
|
|
HC MR MRA UPPER EXTREMITY BIL W CO
|
Facility
|
OP
|
$2,122.52
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
61000075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,910.27 |
| Rate for Payer: Aetna Commercial |
$1,804.14
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cofinity Commercial |
$1,825.37
|
| Rate for Payer: Cofinity Commercial |
$1,485.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,485.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,910.27
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,804.14
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,804.14
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.64
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,337.19
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,570.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,570.66
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR MRA UPPER EXTREMITY BIL WO C
|
Facility
|
OP
|
$2,122.52
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000076
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,910.27 |
| Rate for Payer: Aetna Commercial |
$1,804.14
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cofinity Commercial |
$1,825.37
|
| Rate for Payer: Cofinity Commercial |
$1,485.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,485.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,910.27
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,804.14
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,804.14
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.64
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,337.19
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,570.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,570.66
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR MRA UPPER EXTREMITY BIL WO C
|
Facility
|
IP
|
$2,122.52
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000076
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,337.19 |
| Max. Negotiated Rate |
$1,910.27 |
| Rate for Payer: Aetna Commercial |
$1,804.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.64
|
| Rate for Payer: Cash Price |
$1,698.02
|
| Rate for Payer: Cofinity Commercial |
$1,485.76
|
| Rate for Payer: Cofinity Commercial |
$1,825.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,485.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,698.02
|
| Rate for Payer: Healthscope Commercial |
$1,910.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,804.14
|
| Rate for Payer: PHP Commercial |
$1,804.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.64
|
| Rate for Payer: Priority Health SBD |
$1,337.19
|
|
|
HC MR MRA UPPER EXTREMITY W CO
|
Facility
|
IP
|
$1,903.11
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
61000077
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,198.96 |
| Max. Negotiated Rate |
$1,712.80 |
| Rate for Payer: Aetna Commercial |
$1,617.64
|
| Rate for Payer: Aetna Commercial |
$2,426.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,855.54
|
| Rate for Payer: Cash Price |
$1,522.49
|
| Rate for Payer: Cash Price |
$2,283.74
|
| Rate for Payer: Cofinity Commercial |
$1,332.18
|
| Rate for Payer: Cofinity Commercial |
$1,998.27
|
| Rate for Payer: Cofinity Commercial |
$2,455.02
|
| Rate for Payer: Cofinity Commercial |
$1,636.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,998.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,332.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,283.74
|
| Rate for Payer: Healthscope Commercial |
$1,712.80
|
| Rate for Payer: Healthscope Commercial |
$2,569.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,426.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.64
|
| Rate for Payer: PHP Commercial |
$1,617.64
|
| Rate for Payer: PHP Commercial |
$2,426.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.02
|
| Rate for Payer: Priority Health SBD |
$1,198.96
|
| Rate for Payer: Priority Health SBD |
$1,798.44
|
|
|
HC MR MRA UPPER EXTREMITY W CO
|
Facility
|
OP
|
$2,854.67
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
61000077
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,569.20 |
| Rate for Payer: Aetna Commercial |
$2,426.47
|
| Rate for Payer: Aetna Commercial |
$1,617.64
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,855.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,522.49
|
| Rate for Payer: Cash Price |
$1,522.49
|
| Rate for Payer: Cash Price |
$2,283.74
|
| Rate for Payer: Cash Price |
$2,283.74
|
| Rate for Payer: Cofinity Commercial |
$2,455.02
|
| Rate for Payer: Cofinity Commercial |
$1,332.18
|
| Rate for Payer: Cofinity Commercial |
$1,636.67
|
| Rate for Payer: Cofinity Commercial |
$1,998.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,998.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,332.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,283.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,569.20
|
| Rate for Payer: Healthscope Commercial |
$1,712.80
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,426.47
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,617.64
|
| Rate for Payer: PHP Commercial |
$2,426.47
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.02
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,798.44
|
| Rate for Payer: Priority Health SBD |
$1,198.96
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,112.46
|
| Rate for Payer: UHC Core |
$1,408.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,112.46
|
| Rate for Payer: UHC Exchange |
$1,408.30
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
OP
|
$2,635.11
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,371.60 |
| Rate for Payer: Aetna Commercial |
$2,239.84
|
| Rate for Payer: Aetna Commercial |
$1,493.23
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,712.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cofinity Commercial |
$2,266.19
|
| Rate for Payer: Cofinity Commercial |
$1,229.72
|
| Rate for Payer: Cofinity Commercial |
$1,510.80
|
| Rate for Payer: Cofinity Commercial |
$1,844.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,844.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,371.60
|
| Rate for Payer: Healthscope Commercial |
$1,581.07
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,239.84
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,493.23
|
| Rate for Payer: PHP Commercial |
$2,239.84
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.88
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,660.12
|
| Rate for Payer: Priority Health SBD |
$1,106.75
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,949.98
|
| Rate for Payer: UHC Core |
$1,299.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,949.98
|
| Rate for Payer: UHC Exchange |
$1,299.99
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR MRA UPPER EXTREMITY WO C
|
Facility
|
IP
|
$1,756.74
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
61000078
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,106.75 |
| Max. Negotiated Rate |
$1,581.07 |
| Rate for Payer: Aetna Commercial |
$1,493.23
|
| Rate for Payer: Aetna Commercial |
$2,239.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,712.82
|
| Rate for Payer: Cash Price |
$1,405.39
|
| Rate for Payer: Cash Price |
$2,108.09
|
| Rate for Payer: Cofinity Commercial |
$1,229.72
|
| Rate for Payer: Cofinity Commercial |
$1,844.58
|
| Rate for Payer: Cofinity Commercial |
$2,266.19
|
| Rate for Payer: Cofinity Commercial |
$1,510.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,844.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.09
|
| Rate for Payer: Healthscope Commercial |
$1,581.07
|
| Rate for Payer: Healthscope Commercial |
$2,371.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,239.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.23
|
| Rate for Payer: PHP Commercial |
$1,493.23
|
| Rate for Payer: PHP Commercial |
$2,239.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.88
|
| Rate for Payer: Priority Health SBD |
$1,106.75
|
| Rate for Payer: Priority Health SBD |
$1,660.12
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
OP
|
$3,074.07
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,766.66 |
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Cofinity Commercial |
$1,434.57
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Cofinity Commercial |
$2,151.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,151.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.96
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,936.66
|
| Rate for Payer: Priority Health SBD |
$1,291.11
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,274.81
|
| Rate for Payer: UHC Core |
$1,516.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,274.81
|
| Rate for Payer: UHC Exchange |
$1,516.54
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR MRA UPPER EXTREMITY WO W
|
Facility
|
IP
|
$2,049.38
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
61000079
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,291.11 |
| Max. Negotiated Rate |
$1,844.44 |
| Rate for Payer: Aetna Commercial |
$1,741.97
|
| Rate for Payer: Aetna Commercial |
$2,612.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.15
|
| Rate for Payer: Cash Price |
$1,639.50
|
| Rate for Payer: Cash Price |
$2,459.26
|
| Rate for Payer: Cofinity Commercial |
$1,434.57
|
| Rate for Payer: Cofinity Commercial |
$2,151.85
|
| Rate for Payer: Cofinity Commercial |
$2,643.70
|
| Rate for Payer: Cofinity Commercial |
$1,762.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,151.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,639.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.26
|
| Rate for Payer: Healthscope Commercial |
$1,844.44
|
| Rate for Payer: Healthscope Commercial |
$2,766.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.97
|
| Rate for Payer: PHP Commercial |
$1,741.97
|
| Rate for Payer: PHP Commercial |
$2,612.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
| Rate for Payer: Priority Health SBD |
$1,291.11
|
| Rate for Payer: Priority Health SBD |
$1,936.66
|
|
|
HC MR MRCP
|
Facility
|
IP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,329.58 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
|
|
HC MR MRCP
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,561.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,561.73
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$633.41 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.52
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$703.79
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$703.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health SBD |
$633.41
|
|
|
HC MR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,005.41
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61000081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$904.87 |
| Rate for Payer: Aetna Commercial |
$854.60
|
| Rate for Payer: Aetna Medicare |
$502.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.52
|
| Rate for Payer: BCBS Complete |
$402.16
|
| Rate for Payer: Cash Price |
$804.33
|
| Rate for Payer: Cofinity Commercial |
$703.79
|
| Rate for Payer: Cofinity Commercial |
$864.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$703.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$904.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$854.60
|
| Rate for Payer: PHP Commercial |
$854.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.52
|
| Rate for Payer: Priority Health SBD |
$633.41
|
| Rate for Payer: UHC Core |
$744.00
|
| Rate for Payer: UHC Exchange |
$744.00
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
OP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Cofinity Commercial |
$1,551.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,551.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,396.69
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,640.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,640.56
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ONLY HEAD W CON
|
Facility
|
IP
|
$2,216.97
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,396.69 |
| Max. Negotiated Rate |
$1,995.27 |
| Rate for Payer: Aetna Commercial |
$1,884.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.03
|
| Rate for Payer: Cash Price |
$1,773.58
|
| Rate for Payer: Cofinity Commercial |
$1,551.88
|
| Rate for Payer: Cofinity Commercial |
$1,906.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,551.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.58
|
| Rate for Payer: Healthscope Commercial |
$1,995.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.42
|
| Rate for Payer: PHP Commercial |
$1,884.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,441.03
|
| Rate for Payer: Priority Health SBD |
$1,396.69
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
OP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Cofinity Commercial |
$1,502.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,502.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,352.29
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,588.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,588.40
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR ORBITS FACE NECK W CON
|
Facility
|
IP
|
$2,146.49
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,352.29 |
| Max. Negotiated Rate |
$1,931.84 |
| Rate for Payer: Aetna Commercial |
$1,824.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,395.22
|
| Rate for Payer: Cash Price |
$1,717.19
|
| Rate for Payer: Cofinity Commercial |
$1,502.54
|
| Rate for Payer: Cofinity Commercial |
$1,845.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,502.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.19
|
| Rate for Payer: Healthscope Commercial |
$1,931.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.52
|
| Rate for Payer: PHP Commercial |
$1,824.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.22
|
| Rate for Payer: Priority Health SBD |
$1,352.29
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,282.13 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,424.58
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
|
|
HC MR ORBITS FACE NECK WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Commercial |
$1,424.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,424.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.83
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,505.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,505.99
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
IP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,756.91 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,812.68
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$1,952.12
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,952.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health SBD |
$1,756.91
|
|
|
HC MR ORBITS FACE NECK WO/W CON
|
Facility
|
OP
|
$2,788.74
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,509.87 |
| Rate for Payer: Aetna Commercial |
$2,370.43
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,812.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cash Price |
$2,230.99
|
| Rate for Payer: Cofinity Commercial |
$2,398.32
|
| Rate for Payer: Cofinity Commercial |
$1,952.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,952.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,509.87
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,370.43
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$2,370.43
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,812.68
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,756.91
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,063.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,063.67
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR PELVIS W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,413.20 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.07
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,570.23
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,570.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health SBD |
$1,413.20
|
|
|
HC MR PELVIS W CON
|
Facility
|
OP
|
$2,243.18
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$2,018.86 |
| Rate for Payer: Aetna Commercial |
$1,906.70
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$1,929.13
|
| Rate for Payer: Cofinity Commercial |
$1,570.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,570.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$2,018.86
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,906.70
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$1,413.20
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,659.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,659.95
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC MR PELVIS WO CON
|
Facility
|
IP
|
$2,032.74
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,280.63 |
| Max. Negotiated Rate |
$1,829.47 |
| Rate for Payer: Aetna Commercial |
$1,727.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.28
|
| Rate for Payer: Cash Price |
$1,626.19
|
| Rate for Payer: Cofinity Commercial |
$1,422.92
|
| Rate for Payer: Cofinity Commercial |
$1,748.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,626.19
|
| Rate for Payer: Healthscope Commercial |
$1,829.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.83
|
| Rate for Payer: PHP Commercial |
$1,727.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.28
|
| Rate for Payer: Priority Health SBD |
$1,280.63
|
|
