|
HC MR SPINE THORACIC WO LIMITED
|
Facility
|
OP
|
$711.11
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
61200005
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$604.44
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$238.26
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$568.89
|
| Rate for Payer: Cash Price |
$568.89
|
| Rate for Payer: Cofinity Commercial |
$611.55
|
| Rate for Payer: Cofinity Commercial |
$497.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$640.00
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.44
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$604.44
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$448.00
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$526.22
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,639.81
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,663.08 |
| Max. Negotiated Rate |
$2,375.83 |
| Rate for Payer: Aetna Commercial |
$2,243.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: Cash Price |
$2,111.85
|
| Rate for Payer: Cofinity Commercial |
$1,847.87
|
| Rate for Payer: Cofinity Commercial |
$2,270.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,847.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,111.85
|
| Rate for Payer: Healthscope Commercial |
$2,375.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,243.84
|
| Rate for Payer: PHP Commercial |
$2,243.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,715.88
|
| Rate for Payer: Priority Health SBD |
$1,663.08
|
|
|
HC MR SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,639.81
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,375.83 |
| Rate for Payer: Aetna Commercial |
$2,243.84
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$419.29
|
| Rate for Payer: BCN Commercial |
$419.29
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,111.85
|
| Rate for Payer: Cash Price |
$2,111.85
|
| Rate for Payer: Cofinity Commercial |
$2,270.24
|
| Rate for Payer: Cofinity Commercial |
$1,847.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,847.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,111.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,375.83
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,243.84
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,243.84
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,715.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,663.08
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,953.46
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR SPINE THORACIC WO W LTD
|
Facility
|
IP
|
$924.50
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$582.44 |
| Max. Negotiated Rate |
$832.05 |
| Rate for Payer: Aetna Commercial |
$785.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.92
|
| Rate for Payer: Cash Price |
$739.60
|
| Rate for Payer: Cofinity Commercial |
$647.15
|
| Rate for Payer: Cofinity Commercial |
$795.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$647.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.60
|
| Rate for Payer: Healthscope Commercial |
$832.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.82
|
| Rate for Payer: PHP Commercial |
$785.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.92
|
| Rate for Payer: Priority Health SBD |
$582.44
|
|
|
HC MR SPINE THORACIC WO W LTD
|
Facility
|
OP
|
$924.50
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
61200016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna Commercial |
$785.82
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$419.29
|
| Rate for Payer: BCN Commercial |
$419.29
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$739.60
|
| Rate for Payer: Cash Price |
$739.60
|
| Rate for Payer: Cofinity Commercial |
$795.07
|
| Rate for Payer: Cofinity Commercial |
$647.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$647.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$832.05
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.82
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$785.82
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$582.44
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$684.13
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR TEMPOROMANDIBULAR JTS
|
Facility
|
IP
|
$2,072.90
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,305.93 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health SBD |
$1,305.93
|
|
|
HC MR TEMPOROMANDIBULAR JTS
|
Facility
|
OP
|
$2,072.90
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,865.61 |
| Rate for Payer: Aetna Commercial |
$1,761.96
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$382.20
|
| Rate for Payer: BCN Commercial |
$382.20
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cash Price |
$1,658.32
|
| Rate for Payer: Cofinity Commercial |
$1,451.03
|
| Rate for Payer: Cofinity Commercial |
$1,782.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,451.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,865.61
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.96
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,761.96
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,305.93
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,533.95
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR UPPER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
OP
|
$2,584.25
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,325.82 |
| Rate for Payer: Aetna Commercial |
$2,196.61
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$560.74
|
| Rate for Payer: BCN Commercial |
$560.74
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cofinity Commercial |
$2,222.46
|
| Rate for Payer: Cofinity Commercial |
$1,808.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,808.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,067.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,325.82
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,196.61
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,196.61
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,679.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,628.08
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,912.34
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR UPPER EXTREM ANY JOINT BIL WO W CON
|
Facility
|
IP
|
$2,584.25
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$2,325.82 |
| Rate for Payer: Aetna Commercial |
$2,196.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.76
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cofinity Commercial |
$1,808.98
|
| Rate for Payer: Cofinity Commercial |
$2,222.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,808.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,067.40
|
| Rate for Payer: Healthscope Commercial |
$2,325.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,196.61
|
| Rate for Payer: PHP Commercial |
$2,196.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,679.76
|
| Rate for Payer: Priority Health SBD |
$1,628.08
|
|
|
HC MR UPPER EXTREM ANY JOINT W CON
|
Facility
|
IP
|
$2,290.86
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,443.24 |
| Max. Negotiated Rate |
$2,061.77 |
| Rate for Payer: Aetna Commercial |
$1,947.23
|
| Rate for Payer: Aetna Commercial |
$2,920.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,489.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.60
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cofinity Commercial |
$1,603.60
|
| Rate for Payer: Cofinity Commercial |
$2,405.41
|
| Rate for Payer: Cofinity Commercial |
$2,955.22
|
| Rate for Payer: Cofinity Commercial |
$1,970.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,405.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,603.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,832.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,749.04
|
| Rate for Payer: Healthscope Commercial |
$2,061.77
|
| Rate for Payer: Healthscope Commercial |
$3,092.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,947.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,920.86
|
| Rate for Payer: PHP Commercial |
$1,947.23
|
| Rate for Payer: PHP Commercial |
$2,920.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,233.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.06
|
| Rate for Payer: Priority Health SBD |
$2,164.87
|
| Rate for Payer: Priority Health SBD |
$1,443.24
|
|
|
HC MR UPPER EXTREM ANY JOINT W CON
|
Facility
|
OP
|
$2,290.86
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$323.53 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,947.23
|
| Rate for Payer: Aetna Commercial |
$2,920.86
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$463.93
|
| Rate for Payer: BCBS Trust/PPO |
$463.93
|
| Rate for Payer: BCN Commercial |
$463.93
|
| Rate for Payer: BCN Commercial |
$463.93
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cash Price |
$2,749.04
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cash Price |
$1,832.69
|
| Rate for Payer: Cofinity Commercial |
$1,603.60
|
| Rate for Payer: Cofinity Commercial |
$2,955.22
|
| Rate for Payer: Cofinity Commercial |
$2,405.41
|
| Rate for Payer: Cofinity Commercial |
$1,970.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,603.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,405.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,832.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,749.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$3,092.67
|
| Rate for Payer: Healthscope Commercial |
$2,061.77
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,947.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,920.86
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,947.23
|
| Rate for Payer: PHP Commercial |
$2,920.86
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,233.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$2,164.87
|
| Rate for Payer: Priority Health SBD |
$1,443.24
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,695.24
|
| Rate for Payer: UHC Exchange |
$2,542.86
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC MR UPPER EXTREM ANY JOINT WO CON
|
Facility
|
IP
|
$1,995.22
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,256.99 |
| Max. Negotiated Rate |
$1,795.70 |
| Rate for Payer: Aetna Commercial |
$1,695.94
|
| Rate for Payer: Aetna Commercial |
$2,543.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,296.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.34
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cofinity Commercial |
$1,396.65
|
| Rate for Payer: Cofinity Commercial |
$2,094.98
|
| Rate for Payer: Cofinity Commercial |
$2,573.83
|
| Rate for Payer: Cofinity Commercial |
$1,715.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,094.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,396.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.26
|
| Rate for Payer: Healthscope Commercial |
$1,795.70
|
| Rate for Payer: Healthscope Commercial |
$2,693.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,543.91
|
| Rate for Payer: PHP Commercial |
$1,695.94
|
| Rate for Payer: PHP Commercial |
$2,543.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.89
|
| Rate for Payer: Priority Health SBD |
$1,885.48
|
| Rate for Payer: Priority Health SBD |
$1,256.99
|
|
|
HC MR UPPER EXTREM ANY JOINT WO CON
|
Facility
|
OP
|
$1,995.22
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,795.70 |
| Rate for Payer: Aetna Commercial |
$1,695.94
|
| Rate for Payer: Aetna Commercial |
$2,543.91
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,296.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$273.45
|
| Rate for Payer: BCBS Trust/PPO |
$273.45
|
| Rate for Payer: BCN Commercial |
$273.45
|
| Rate for Payer: BCN Commercial |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cash Price |
$2,394.26
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cash Price |
$1,596.18
|
| Rate for Payer: Cofinity Commercial |
$1,396.65
|
| Rate for Payer: Cofinity Commercial |
$2,573.83
|
| Rate for Payer: Cofinity Commercial |
$2,094.98
|
| Rate for Payer: Cofinity Commercial |
$1,715.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,396.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,094.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,693.55
|
| Rate for Payer: Healthscope Commercial |
$1,795.70
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,543.91
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,695.94
|
| Rate for Payer: PHP Commercial |
$2,543.91
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,885.48
|
| Rate for Payer: Priority Health SBD |
$1,256.99
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,476.46
|
| Rate for Payer: UHC Exchange |
$2,214.69
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR UPPER EXTREM ANY JOINT WO W CON
|
Facility
|
OP
|
$2,459.37
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,213.43 |
| Rate for Payer: Aetna Commercial |
$2,090.46
|
| Rate for Payer: Aetna Commercial |
$3,135.69
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,397.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$560.74
|
| Rate for Payer: BCBS Trust/PPO |
$560.74
|
| Rate for Payer: BCN Commercial |
$560.74
|
| Rate for Payer: BCN Commercial |
$560.74
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,951.24
|
| Rate for Payer: Cash Price |
$2,951.24
|
| Rate for Payer: Cash Price |
$1,967.50
|
| Rate for Payer: Cash Price |
$1,967.50
|
| Rate for Payer: Cofinity Commercial |
$1,721.56
|
| Rate for Payer: Cofinity Commercial |
$3,172.58
|
| Rate for Payer: Cofinity Commercial |
$2,582.34
|
| Rate for Payer: Cofinity Commercial |
$2,115.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,721.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,582.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,951.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$3,320.14
|
| Rate for Payer: Healthscope Commercial |
$2,213.43
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,090.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,135.69
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,090.46
|
| Rate for Payer: PHP Commercial |
$3,135.69
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,397.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$2,324.10
|
| Rate for Payer: Priority Health SBD |
$1,549.40
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,819.93
|
| Rate for Payer: UHC Exchange |
$2,729.90
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR UPPER EXTREM ANY JOINT WO W CON
|
Facility
|
IP
|
$2,459.37
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,549.40 |
| Max. Negotiated Rate |
$2,213.43 |
| Rate for Payer: Aetna Commercial |
$2,090.46
|
| Rate for Payer: Aetna Commercial |
$3,135.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,397.88
|
| Rate for Payer: Cash Price |
$1,967.50
|
| Rate for Payer: Cash Price |
$2,951.24
|
| Rate for Payer: Cofinity Commercial |
$1,721.56
|
| Rate for Payer: Cofinity Commercial |
$2,582.34
|
| Rate for Payer: Cofinity Commercial |
$3,172.58
|
| Rate for Payer: Cofinity Commercial |
$2,115.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,582.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,721.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,951.24
|
| Rate for Payer: Healthscope Commercial |
$2,213.43
|
| Rate for Payer: Healthscope Commercial |
$3,320.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,090.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,135.69
|
| Rate for Payer: PHP Commercial |
$2,090.46
|
| Rate for Payer: PHP Commercial |
$3,135.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,397.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.59
|
| Rate for Payer: Priority Health SBD |
$2,324.10
|
| Rate for Payer: Priority Health SBD |
$1,549.40
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
IP
|
$2,512.46
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
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 Commercial |
$1,758.72
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,758.72
|
| 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: PHP Commercial |
$2,135.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health SBD |
$1,582.85
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
OP
|
$2,512.46
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$323.53 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$2,135.59
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,633.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$463.93
|
| Rate for Payer: BCN Commercial |
$463.93
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cofinity Commercial |
$2,160.72
|
| Rate for Payer: Cofinity Commercial |
$1,758.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,758.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$2,261.21
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,135.59
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$2,135.59
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,582.85
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,859.22
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
OP
|
$2,297.10
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$273.45
|
| Rate for Payer: BCN Commercial |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Cofinity Commercial |
$1,607.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,699.85
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
IP
|
$2,297.10
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,447.17 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
|
|
HC MR UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
OP
|
$2,463.20
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,216.88 |
| Rate for Payer: Aetna Commercial |
$2,093.72
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,601.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$499.76
|
| Rate for Payer: BCN Commercial |
$499.76
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,970.56
|
| Rate for Payer: Cash Price |
$1,970.56
|
| Rate for Payer: Cofinity Commercial |
$2,118.35
|
| Rate for Payer: Cofinity Commercial |
$1,724.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,724.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,970.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,216.88
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,093.72
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,093.72
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,551.82
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,822.77
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
IP
|
$2,463.20
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,551.82 |
| Max. Negotiated Rate |
$2,216.88 |
| Rate for Payer: Aetna Commercial |
$2,093.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,601.08
|
| Rate for Payer: Cash Price |
$1,970.56
|
| Rate for Payer: Cofinity Commercial |
$1,724.24
|
| Rate for Payer: Cofinity Commercial |
$2,118.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,724.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,970.56
|
| Rate for Payer: Healthscope Commercial |
$2,216.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,093.72
|
| Rate for Payer: PHP Commercial |
$2,093.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.08
|
| Rate for Payer: Priority Health SBD |
$1,551.82
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
IP
|
$2,297.10
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,447.17 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$1,607.97
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
OP
|
$2,297.10
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,067.39 |
| Rate for Payer: Aetna Commercial |
$1,952.54
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$468.96
|
| Rate for Payer: BCN Commercial |
$468.96
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,837.68
|
| Rate for Payer: Cofinity Commercial |
$1,975.51
|
| Rate for Payer: Cofinity Commercial |
$1,607.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,067.39
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,952.54
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,952.54
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,447.17
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,699.85
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
OP
|
$2,584.25
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,325.82 |
| Rate for Payer: Aetna Commercial |
$2,196.61
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$605.36
|
| Rate for Payer: BCN Commercial |
$605.36
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cofinity Commercial |
$2,222.46
|
| Rate for Payer: Cofinity Commercial |
$1,808.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,808.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,067.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,325.82
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,196.61
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,196.61
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,679.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,628.08
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,912.34
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
IP
|
$2,584.25
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$2,325.82 |
| Rate for Payer: Aetna Commercial |
$2,196.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.76
|
| Rate for Payer: Cash Price |
$2,067.40
|
| Rate for Payer: Cofinity Commercial |
$1,808.98
|
| Rate for Payer: Cofinity Commercial |
$2,222.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,808.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,067.40
|
| Rate for Payer: Healthscope Commercial |
$2,325.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,196.61
|
| Rate for Payer: PHP Commercial |
$2,196.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,679.76
|
| Rate for Payer: Priority Health SBD |
$1,628.08
|
|
