|
HC XR INFANT UPPER EXT
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health SBD |
$189.26
|
|
|
HC XR INFANT UPPER EXT BIL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
32000079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$320.48 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$39.72
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR INFANT UPPER EXT BIL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
32000079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
|
|
HC XR JOINT SURVEY 1 VW
|
Facility
|
OP
|
$307.63
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
32000259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$261.49
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$50.74
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$246.10
|
| Rate for Payer: Cash Price |
$246.10
|
| Rate for Payer: Cofinity Commercial |
$215.34
|
| Rate for Payer: Cofinity Commercial |
$264.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$276.87
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.49
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$261.49
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$193.81
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$46.17
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR JOINT SURVEY 1 VW
|
Facility
|
IP
|
$307.63
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
32000259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.81 |
| Max. Negotiated Rate |
$276.87 |
| Rate for Payer: Aetna Commercial |
$261.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.96
|
| Rate for Payer: Cash Price |
$246.10
|
| Rate for Payer: Cofinity Commercial |
$215.34
|
| Rate for Payer: Cofinity Commercial |
$264.56
|
| Rate for Payer: Healthscope Commercial |
$276.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.49
|
| Rate for Payer: PHP Commercial |
$261.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.34
|
| Rate for Payer: Priority Health SBD |
$193.81
|
|
|
HC XR KNEE 1 OR 2 VW
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$43.58
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$189.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$33.73
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR KNEE 1 OR 2 VW
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health SBD |
$189.26
|
|
|
HC XR KNEE 3 VIEWS
|
Facility
|
IP
|
$360.36
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.03 |
| Max. Negotiated Rate |
$324.32 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.23
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$309.91
|
| Rate for Payer: Cofinity Commercial |
$252.25
|
| Rate for Payer: Healthscope Commercial |
$324.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.31
|
| Rate for Payer: PHP Commercial |
$306.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health SBD |
$227.03
|
|
|
HC XR KNEE 3 VIEWS
|
Facility
|
OP
|
$360.36
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$324.32 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$309.91
|
| Rate for Payer: Cofinity Commercial |
$252.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$324.32
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.31
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$306.31
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$227.03
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$40.28
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR KNEE 3 VIEWS BIL
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health SBD |
$300.18
|
|
|
HC XR KNEE 3 VIEWS BIL
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$300.18
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$40.28
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR KNEE 4 VIEWS
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$59.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$46.50
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR KNEE 4 VIEWS
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$43.58
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$33.73
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$270.30
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$59.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$270.30
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$46.50
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$39.29
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
IP
|
$240.19
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$216.17 |
| Rate for Payer: Aetna Commercial |
$204.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cofinity Commercial |
$168.13
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Healthscope Commercial |
$216.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.16
|
| Rate for Payer: PHP Commercial |
$204.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.13
|
| Rate for Payer: Priority Health SBD |
$151.32
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
OP
|
$240.19
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$204.16
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$49.65
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cofinity Commercial |
$168.13
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$216.17
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.16
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$204.16
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$151.32
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$38.31
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.84 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health SBD |
$283.84
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
OP
|
$450.54
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.89 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$283.84
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$42.89
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health SBD |
$72.87
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$76.67
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$60.90
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
