|
HC MR UPPER EXTREM ANY JOINT WO W CON
|
Facility
|
IP
|
$2,508.56
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,881.42 |
| Max. Negotiated Rate |
$2,508.56 |
| Rate for Payer: Aetna Commercial |
$2,257.70
|
| Rate for Payer: Aetna Commercial |
$3,386.55
|
| Rate for Payer: ASR ASR |
$2,433.30
|
| Rate for Payer: ASR ASR |
$3,649.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,060.03
|
| Rate for Payer: BCBS Trust/PPO |
$3,090.04
|
| Rate for Payer: BCN Commercial |
$2,060.03
|
| Rate for Payer: BCN Commercial |
$3,090.04
|
| Rate for Payer: Cash Price |
$3,010.26
|
| Rate for Payer: Cash Price |
$2,006.85
|
| Rate for Payer: Cofinity Commercial |
$3,537.06
|
| Rate for Payer: Cofinity Commercial |
$2,358.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.26
|
| Rate for Payer: Healthscope Commercial |
$2,433.30
|
| Rate for Payer: Healthscope Commercial |
$3,649.95
|
| Rate for Payer: Healthscope Whirlpool |
$3,762.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,508.56
|
| Rate for Payer: Mclaren Commercial |
$3,386.55
|
| Rate for Payer: Mclaren Commercial |
$2,257.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.28
|
| Rate for Payer: Nomi Health Commercial |
$3,085.52
|
| Rate for Payer: Nomi Health Commercial |
$2,057.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,881.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,822.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,311.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.53
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
OP
|
$2,562.71
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,562.71 |
| Rate for Payer: Aetna Commercial |
$2,306.44
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$2,485.83
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,112.95
|
| Rate for Payer: BCN Commercial |
$2,112.95
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cofinity Commercial |
$2,408.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,485.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,562.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$2,306.44
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.30
|
| Rate for Payer: Nomi Health Commercial |
$2,101.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.03
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,255.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT W CON
|
Facility
|
IP
|
$2,562.71
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,922.03 |
| Max. Negotiated Rate |
$2,562.71 |
| Rate for Payer: Aetna Commercial |
$2,306.44
|
| Rate for Payer: ASR ASR |
$2,485.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,104.50
|
| Rate for Payer: BCN Commercial |
$2,104.50
|
| Rate for Payer: Cash Price |
$2,050.17
|
| Rate for Payer: Cofinity Commercial |
$2,408.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.17
|
| Rate for Payer: Healthscope Commercial |
$2,485.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,562.71
|
| Rate for Payer: Mclaren Commercial |
$2,306.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.30
|
| Rate for Payer: Nomi Health Commercial |
$2,101.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,922.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,255.18
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,757.28 |
| Max. Negotiated Rate |
$2,343.04 |
| Rate for Payer: Aetna Commercial |
$2,108.74
|
| Rate for Payer: ASR ASR |
$2,272.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.10
|
| Rate for Payer: BCN Commercial |
$1,924.10
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Commercial |
$2,202.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Healthscope Commercial |
$2,272.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,343.04
|
| Rate for Payer: Mclaren Commercial |
$2,108.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.58
|
| Rate for Payer: Nomi Health Commercial |
$1,921.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,061.88
|
|
|
HC MR UPPER EXTREM BIL ANY JOINT WO CON
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,343.04 |
| Rate for Payer: Aetna Commercial |
$2,108.74
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$2,272.75
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.84
|
| Rate for Payer: BCN Commercial |
$1,931.84
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Commercial |
$2,202.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,272.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,343.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,108.74
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.58
|
| Rate for Payer: Nomi Health Commercial |
$1,921.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,838.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,471.07
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,061.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
OP
|
$2,512.46
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,512.46 |
| Rate for Payer: Aetna Commercial |
$2,261.21
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,437.09
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.52
|
| Rate for Payer: BCN Commercial |
$2,071.52
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cofinity Commercial |
$2,361.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,437.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,512.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,261.21
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,135.59
|
| Rate for Payer: Nomi Health Commercial |
$2,060.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,884.35
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,210.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM BIL NO JOINT W CON
|
Facility
|
IP
|
$2,512.46
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,884.35 |
| Max. Negotiated Rate |
$2,512.46 |
| Rate for Payer: Aetna Commercial |
$2,261.21
|
| Rate for Payer: ASR ASR |
$2,437.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,063.23
|
| Rate for Payer: BCN Commercial |
$2,063.23
|
| Rate for Payer: Cash Price |
$2,009.97
|
| Rate for Payer: Cofinity Commercial |
$2,361.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,009.97
|
| Rate for Payer: Healthscope Commercial |
$2,437.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,512.46
|
| Rate for Payer: Mclaren Commercial |
$2,261.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,135.59
|
| Rate for Payer: Nomi Health Commercial |
$2,060.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,884.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,210.96
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,343.04 |
| Rate for Payer: Aetna Commercial |
$2,108.74
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$2,272.75
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.84
|
| Rate for Payer: BCN Commercial |
$1,931.84
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Commercial |
$2,202.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,272.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,343.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,108.74
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.58
|
| Rate for Payer: Nomi Health Commercial |
$1,921.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,837.63
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,470.10
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,061.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO CON
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,757.28 |
| Max. Negotiated Rate |
$2,343.04 |
| Rate for Payer: Aetna Commercial |
$2,108.74
|
| Rate for Payer: ASR ASR |
$2,272.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.10
|
| Rate for Payer: BCN Commercial |
$1,924.10
|
| Rate for Payer: Cash Price |
$1,874.43
|
| Rate for Payer: Cofinity Commercial |
$2,202.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.43
|
| Rate for Payer: Healthscope Commercial |
$2,272.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,343.04
|
| Rate for Payer: Mclaren Commercial |
$2,108.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.58
|
| Rate for Payer: Nomi Health Commercial |
$1,921.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,757.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,061.88
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
IP
|
$2,635.94
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,976.95 |
| Max. Negotiated Rate |
$2,635.94 |
| Rate for Payer: Aetna Commercial |
$2,372.35
|
| Rate for Payer: ASR ASR |
$2,556.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,164.63
|
| Rate for Payer: BCN Commercial |
$2,164.63
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Commercial |
$2,477.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Healthscope Commercial |
$2,556.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,635.94
|
| Rate for Payer: Mclaren Commercial |
$2,372.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,240.55
|
| Rate for Payer: Nomi Health Commercial |
$2,161.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,319.63
|
|
|
HC MR UPPER EXTREM BIL NO JOINT WO W CON
|
Facility
|
OP
|
$2,635.94
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,635.94 |
| Rate for Payer: Aetna Commercial |
$2,372.35
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,556.86
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.33
|
| Rate for Payer: BCN Commercial |
$2,173.33
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cash Price |
$2,108.75
|
| Rate for Payer: Cofinity Commercial |
$2,477.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,108.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,556.86
|
| Rate for Payer: Healthscope Whirlpool |
$2,635.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,372.35
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,240.55
|
| Rate for Payer: Nomi Health Commercial |
$2,161.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,976.95
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,319.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
OP
|
$2,375.75
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,375.75 |
| Rate for Payer: Aetna Commercial |
$2,138.18
|
| Rate for Payer: Aetna Commercial |
$3,207.27
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,304.48
|
| Rate for Payer: ASR ASR |
$3,456.72
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,958.81
|
| Rate for Payer: BCN Commercial |
$2,938.21
|
| Rate for Payer: BCN Commercial |
$1,958.81
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cofinity Commercial |
$2,233.20
|
| Rate for Payer: Cofinity Commercial |
$3,349.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,304.48
|
| Rate for Payer: Healthscope Commercial |
$3,456.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,375.75
|
| Rate for Payer: Healthscope Whirlpool |
$3,563.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$3,207.27
|
| Rate for Payer: Mclaren Commercial |
$2,138.18
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,019.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,029.09
|
| Rate for Payer: Nomi Health Commercial |
$2,922.18
|
| Rate for Payer: Nomi Health Commercial |
$1,948.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,672.72
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,135.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,090.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
IP
|
$2,375.75
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,781.81 |
| Max. Negotiated Rate |
$2,375.75 |
| Rate for Payer: Aetna Commercial |
$2,138.18
|
| Rate for Payer: Aetna Commercial |
$3,207.27
|
| Rate for Payer: ASR ASR |
$2,304.48
|
| Rate for Payer: ASR ASR |
$3,456.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,926.45
|
| Rate for Payer: BCN Commercial |
$1,950.97
|
| Rate for Payer: BCN Commercial |
$2,926.45
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cofinity Commercial |
$3,349.81
|
| Rate for Payer: Cofinity Commercial |
$2,233.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.90
|
| Rate for Payer: Healthscope Commercial |
$2,304.48
|
| Rate for Payer: Healthscope Commercial |
$3,456.72
|
| Rate for Payer: Healthscope Whirlpool |
$3,563.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,375.75
|
| Rate for Payer: Mclaren Commercial |
$3,207.27
|
| Rate for Payer: Mclaren Commercial |
$2,138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,029.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,019.39
|
| Rate for Payer: Nomi Health Commercial |
$2,922.18
|
| Rate for Payer: Nomi Health Commercial |
$1,948.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,672.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,135.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,090.66
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,526.34 |
| Max. Negotiated Rate |
$2,035.12 |
| Rate for Payer: Aetna Commercial |
$1,831.61
|
| Rate for Payer: Aetna Commercial |
$2,747.42
|
| Rate for Payer: ASR ASR |
$1,974.07
|
| Rate for Payer: ASR ASR |
$2,961.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,506.87
|
| Rate for Payer: BCN Commercial |
$1,671.24
|
| Rate for Payer: BCN Commercial |
$2,506.87
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Commercial |
$2,869.53
|
| Rate for Payer: Cofinity Commercial |
$1,913.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| Rate for Payer: Healthscope Commercial |
$1,974.07
|
| Rate for Payer: Healthscope Commercial |
$2,961.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,052.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,035.12
|
| Rate for Payer: Mclaren Commercial |
$2,747.42
|
| Rate for Payer: Mclaren Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Nomi Health Commercial |
$2,503.21
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.91
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,035.12 |
| Rate for Payer: Aetna Commercial |
$1,831.61
|
| Rate for Payer: Aetna Commercial |
$2,747.42
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$1,974.07
|
| Rate for Payer: ASR ASR |
$2,961.11
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,516.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.96
|
| Rate for Payer: BCN Commercial |
$2,516.94
|
| Rate for Payer: BCN Commercial |
$1,677.96
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cofinity Commercial |
$1,913.01
|
| Rate for Payer: Cofinity Commercial |
$2,869.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,974.07
|
| Rate for Payer: Healthscope Commercial |
$2,961.11
|
| Rate for Payer: Healthscope Whirlpool |
$2,035.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,052.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$2,747.42
|
| Rate for Payer: Mclaren Commercial |
$1,831.61
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Nomi Health Commercial |
$2,503.21
|
| Rate for Payer: Nomi Health Commercial |
$1,668.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,837.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,837.63
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,470.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,470.10
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,686.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,790.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
IP
|
$2,336.68
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,752.51 |
| Max. Negotiated Rate |
$2,336.68 |
| Rate for Payer: Aetna Commercial |
$2,103.01
|
| Rate for Payer: Aetna Commercial |
$3,154.53
|
| Rate for Payer: ASR ASR |
$2,266.58
|
| Rate for Payer: ASR ASR |
$3,399.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,878.33
|
| Rate for Payer: BCN Commercial |
$1,918.88
|
| Rate for Payer: BCN Commercial |
$2,878.33
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cofinity Commercial |
$3,294.73
|
| Rate for Payer: Cofinity Commercial |
$2,196.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Healthscope Commercial |
$2,266.58
|
| Rate for Payer: Healthscope Commercial |
$3,399.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,505.03
|
| Rate for Payer: Healthscope Whirlpool |
$2,336.68
|
| Rate for Payer: Mclaren Commercial |
$3,154.53
|
| Rate for Payer: Mclaren Commercial |
$2,103.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Nomi Health Commercial |
$2,874.12
|
| Rate for Payer: Nomi Health Commercial |
$1,916.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,084.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,056.28
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
OP
|
$2,336.68
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,336.68 |
| Rate for Payer: Aetna Commercial |
$2,103.01
|
| Rate for Payer: Aetna Commercial |
$3,154.53
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,266.58
|
| Rate for Payer: ASR ASR |
$3,399.88
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,889.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.59
|
| Rate for Payer: BCN Commercial |
$2,889.90
|
| Rate for Payer: BCN Commercial |
$1,926.59
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cofinity Commercial |
$2,196.48
|
| Rate for Payer: Cofinity Commercial |
$3,294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,266.58
|
| Rate for Payer: Healthscope Commercial |
$3,399.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,336.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,505.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$3,154.53
|
| Rate for Payer: Mclaren Commercial |
$2,103.01
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Nomi Health Commercial |
$2,874.12
|
| Rate for Payer: Nomi Health Commercial |
$1,916.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,717.18
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.74
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,084.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,056.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MSMART BM CMPT1
|
Facility
|
IP
|
$293.76
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: ASR ASR |
$284.95
|
| Rate for Payer: BCBS Trust/PPO |
$241.24
|
| Rate for Payer: BCN Commercial |
$241.24
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Commercial |
$276.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Healthscope Commercial |
$284.95
|
| Rate for Payer: Healthscope Whirlpool |
$293.76
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.51
|
|
|
HC MSMART BM CMPT1
|
Facility
|
OP
|
$293.76
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: Aetna Medicare |
$51.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: ASR ASR |
$284.95
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$242.21
|
| Rate for Payer: BCN Commercial |
$242.21
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Commercial |
$276.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$284.95
|
| Rate for Payer: Healthscope Whirlpool |
$293.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Mclaren Medicaid |
$51.92
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$28.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$240.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: PHP Medicaid |
$27.83
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.39
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health Narrow Network |
$205.93
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.48
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP DNSP |
$51.92
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC MSMART BM CMPT2
|
Facility
|
OP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna Medicare |
$357.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: ASR ASR |
$198.79
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$168.97
|
| Rate for Payer: BCN Commercial |
$168.97
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Healthscope Whirlpool |
$204.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.16
|
| Rate for Payer: Mclaren Commercial |
$184.45
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$196.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.20
|
| Rate for Payer: Nomi Health Commercial |
$168.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.71
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$392.88
|
| Rate for Payer: PHP Medicaid |
$191.44
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$553.60
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP DNSP |
$357.16
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC MSMART BM CMPT2
|
Facility
|
IP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$153.71 |
| Max. Negotiated Rate |
$204.94 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: ASR ASR |
$198.79
|
| Rate for Payer: BCBS Trust/PPO |
$168.30
|
| Rate for Payer: BCN Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.95
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Healthscope Whirlpool |
$204.94
|
| Rate for Payer: Mclaren Commercial |
$184.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.20
|
| Rate for Payer: Nomi Health Commercial |
$168.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.35
|
|
|
HC MSMART BM CMPT3
|
Facility
|
IP
|
$179.99
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$134.99 |
| Max. Negotiated Rate |
$179.99 |
| Rate for Payer: Aetna Commercial |
$161.99
|
| Rate for Payer: ASR ASR |
$174.59
|
| Rate for Payer: BCBS Trust/PPO |
$147.81
|
| Rate for Payer: BCN Commercial |
$147.81
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$169.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$174.59
|
| Rate for Payer: Healthscope Whirlpool |
$179.99
|
| Rate for Payer: Mclaren Commercial |
$161.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.99
|
| Rate for Payer: Nomi Health Commercial |
$147.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.39
|
|
|
HC MSMART BM CMPT3
|
Facility
|
OP
|
$179.99
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$179.99 |
| Rate for Payer: Aetna Commercial |
$161.99
|
| Rate for Payer: Aetna Medicare |
$66.60
|
| Rate for Payer: ASR ASR |
$174.59
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.40
|
| Rate for Payer: BCN Commercial |
$148.40
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$169.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$174.59
|
| Rate for Payer: Healthscope Whirlpool |
$179.99
|
| Rate for Payer: Mclaren Commercial |
$161.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.99
|
| Rate for Payer: Nomi Health Commercial |
$147.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.39
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
OP
|
$74.61
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$67.15
|
| Rate for Payer: Aetna Medicare |
$41.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: ASR ASR |
$72.37
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.52
|
| Rate for Payer: BCN Commercial |
$61.52
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Healthscope Whirlpool |
$74.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.68
|
| Rate for Payer: Mclaren Commercial |
$67.15
|
| Rate for Payer: Mclaren Medicaid |
$41.68
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: Meridian Medicaid |
$22.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.42
|
| Rate for Payer: Nomi Health Commercial |
$61.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.96
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: PHP Medicaid |
$22.34
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.37
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow Network |
$52.30
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.68
|
| Rate for Payer: UHC Exchange |
$64.60
|
| Rate for Payer: UHC Medicaid |
$21.80
|
| Rate for Payer: UHCCP DNSP |
$41.68
|
| Rate for Payer: UHCCP Medicaid |
$21.80
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
IP
|
$74.61
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.96 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$67.15
|
| Rate for Payer: ASR ASR |
$72.37
|
| Rate for Payer: BCBS Trust/PPO |
$61.27
|
| Rate for Payer: BCN Commercial |
$61.27
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.69
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Healthscope Whirlpool |
$74.61
|
| Rate for Payer: Mclaren Commercial |
$67.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.42
|
| Rate for Payer: Nomi Health Commercial |
$61.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.66
|
|
