|
HC XR BONE SURVEY INFANT
|
Facility
|
IP
|
$380.35
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
32000258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.62 |
| Max. Negotiated Rate |
$342.32 |
| Rate for Payer: Aetna Commercial |
$323.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Cash Price |
$304.28
|
| Rate for Payer: Cofinity Commercial |
$266.24
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.30
|
| Rate for Payer: PHP Commercial |
$323.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.24
|
| Rate for Payer: Priority Health SBD |
$239.62
|
|
|
HC XR BONE SURVEY (METS) LTD
|
Facility
|
OP
|
$302.08
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
32000298
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$256.77
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.35
|
| 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 |
$73.36
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$241.66
|
| Rate for Payer: Cash Price |
$241.66
|
| Rate for Payer: Cofinity Commercial |
$259.79
|
| Rate for Payer: Cofinity Commercial |
$211.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$271.87
|
| 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 |
$256.77
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$256.77
|
| 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 |
$211.46
|
| 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 |
$190.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$64.18
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR BONE SURVEY (METS) LTD
|
Facility
|
IP
|
$302.08
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
32000298
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.31 |
| Max. Negotiated Rate |
$271.87 |
| Rate for Payer: Aetna Commercial |
$256.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.35
|
| Rate for Payer: Cash Price |
$241.66
|
| Rate for Payer: Cofinity Commercial |
$211.46
|
| Rate for Payer: Cofinity Commercial |
$259.79
|
| Rate for Payer: Healthscope Commercial |
$271.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.77
|
| Rate for Payer: PHP Commercial |
$256.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.46
|
| Rate for Payer: Priority Health SBD |
$190.31
|
|
|
HC XR CHEST 2 VIEWS
|
Facility
|
OP
|
$297.74
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
32400010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$267.97 |
| Rate for Payer: Aetna Commercial |
$253.08
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.53
|
| 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 |
$38.61
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$238.19
|
| Rate for Payer: Cash Price |
$238.19
|
| Rate for Payer: Cofinity Commercial |
$256.06
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$267.97
|
| 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 |
$253.08
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$253.08
|
| 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 |
$208.42
|
| 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 |
$187.58
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$33.07
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CHEST 2 VIEWS
|
Facility
|
IP
|
$297.74
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
32400010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$187.58 |
| Max. Negotiated Rate |
$267.97 |
| Rate for Payer: Aetna Commercial |
$253.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.53
|
| Rate for Payer: Cash Price |
$238.19
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Cofinity Commercial |
$256.06
|
| Rate for Payer: Healthscope Commercial |
$267.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.08
|
| Rate for Payer: PHP Commercial |
$253.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.42
|
| Rate for Payer: Priority Health SBD |
$187.58
|
|
|
HC XR CHEST 3 VIEWS
|
Facility
|
OP
|
$329.87
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
32400011
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$296.88 |
| Rate for Payer: Aetna Commercial |
$280.39
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.42
|
| 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 |
$48.54
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cofinity Commercial |
$283.69
|
| Rate for Payer: Cofinity Commercial |
$230.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$296.88
|
| 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 |
$280.39
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$280.39
|
| 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 |
$230.91
|
| 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 |
$207.82
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$41.59
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CHEST 3 VIEWS
|
Facility
|
IP
|
$329.87
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
32400011
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$296.88 |
| Rate for Payer: Aetna Commercial |
$280.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.42
|
| Rate for Payer: Cash Price |
$263.90
|
| Rate for Payer: Cofinity Commercial |
$230.91
|
| Rate for Payer: Cofinity Commercial |
$283.69
|
| Rate for Payer: Healthscope Commercial |
$296.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.39
|
| Rate for Payer: PHP Commercial |
$280.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.91
|
| Rate for Payer: Priority Health SBD |
$207.82
|
|
|
HC XR CHEST 4 OR MORE VIEWS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
32400012
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$307.70
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.30
|
| 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 |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$253.40
|
| Rate for Payer: Cofinity Commercial |
$311.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$325.80
|
| 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 |
$307.70
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$307.70
|
| 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 |
$253.40
|
| 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 |
$228.06
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$44.86
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR CHEST 4 OR MORE VIEWS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
32400012
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$228.06 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Aetna Commercial |
$307.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.30
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$253.40
|
| Rate for Payer: Cofinity Commercial |
$311.32
|
| Rate for Payer: Healthscope Commercial |
$325.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.70
|
| Rate for Payer: PHP Commercial |
$307.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.40
|
| Rate for Payer: Priority Health SBD |
$228.06
|
|
|
HC XR CHEST ABD FOREIG BOD CHILD
|
Facility
|
OP
|
$270.56
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$229.98
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.86
|
| 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 |
$35.30
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cofinity Commercial |
$232.68
|
| Rate for Payer: Cofinity Commercial |
$189.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$243.50
|
| 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 |
$229.98
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$229.98
|
| 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 |
$189.39
|
| 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 |
$170.45
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.81
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CHEST ABD FOREIG BOD CHILD
|
Facility
|
IP
|
$270.56
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.45 |
| Max. Negotiated Rate |
$243.50 |
| Rate for Payer: Aetna Commercial |
$229.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.86
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cofinity Commercial |
$189.39
|
| Rate for Payer: Cofinity Commercial |
$232.68
|
| Rate for Payer: Healthscope Commercial |
$243.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.98
|
| Rate for Payer: PHP Commercial |
$229.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.39
|
| Rate for Payer: Priority Health SBD |
$170.45
|
|
|
HC XR CHEST SINGLE VIEW
|
Facility
|
OP
|
$265.61
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
32400009
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$225.77
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.65
|
| 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 |
$28.68
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$212.49
|
| Rate for Payer: Cash Price |
$212.49
|
| Rate for Payer: Cofinity Commercial |
$228.42
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$239.05
|
| 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 |
$225.77
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$225.77
|
| 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 |
$185.93
|
| 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 |
$167.33
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$25.21
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CHEST SINGLE VIEW
|
Facility
|
IP
|
$265.61
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
32400009
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$167.33 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: Aetna Commercial |
$225.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.65
|
| Rate for Payer: Cash Price |
$212.49
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Cofinity Commercial |
$228.42
|
| Rate for Payer: Healthscope Commercial |
$239.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.77
|
| Rate for Payer: PHP Commercial |
$225.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health SBD |
$167.33
|
|
|
HC XR CHOLANGIOGRAM IN OR
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
32000149
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.25
|
| Rate for Payer: BCBS Complete |
$200.15
|
| Rate for Payer: BCBS Trust/PPO |
$67.85
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$350.27
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health SBD |
$315.24
|
|
|
HC XR CHOLANGIOGRAM IN OR
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
32000149
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.24 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.25
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$350.27
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health SBD |
$315.24
|
|
|
HC XR CLAVICLE
|
Facility
|
OP
|
$310.28
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
32000060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$279.25 |
| Rate for Payer: Aetna Commercial |
$263.74
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.68
|
| 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 |
$40.27
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$248.22
|
| Rate for Payer: Cash Price |
$248.22
|
| Rate for Payer: Cofinity Commercial |
$266.84
|
| Rate for Payer: Cofinity Commercial |
$217.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$279.25
|
| 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 |
$263.74
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$263.74
|
| 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 |
$217.20
|
| 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 |
$195.48
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$32.09
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CLAVICLE
|
Facility
|
IP
|
$310.28
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
32000060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.48 |
| Max. Negotiated Rate |
$279.25 |
| Rate for Payer: Aetna Commercial |
$263.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.68
|
| Rate for Payer: Cash Price |
$248.22
|
| Rate for Payer: Cofinity Commercial |
$217.20
|
| Rate for Payer: Cofinity Commercial |
$266.84
|
| Rate for Payer: Healthscope Commercial |
$279.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.74
|
| Rate for Payer: PHP Commercial |
$263.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.20
|
| Rate for Payer: Priority Health SBD |
$195.48
|
|
|
HC XR CLAVICLE BIL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
32000061
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.09 |
| 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 |
$40.27
|
| 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 |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| 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) |
$35.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$32.09
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR CLAVICLE BIL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
32000061
|
|
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 COLON
|
Facility
|
OP
|
$840.63
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$756.57 |
| Rate for Payer: Aetna Commercial |
$714.54
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$177.06
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cofinity Commercial |
$722.94
|
| Rate for Payer: Cofinity Commercial |
$588.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$756.57
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$714.54
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$714.54
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.44
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$529.60
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$150.62
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR COLON
|
Facility
|
IP
|
$840.63
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$529.60 |
| Max. Negotiated Rate |
$756.57 |
| Rate for Payer: Aetna Commercial |
$714.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.41
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cofinity Commercial |
$588.44
|
| Rate for Payer: Cofinity Commercial |
$722.94
|
| Rate for Payer: Healthscope Commercial |
$756.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$714.54
|
| Rate for Payer: PHP Commercial |
$714.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.44
|
| Rate for Payer: Priority Health SBD |
$529.60
|
|
|
HC XR COLON HIGH DENSITY
|
Facility
|
IP
|
$1,200.85
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
32000146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$756.54 |
| Max. Negotiated Rate |
$1,080.76 |
| Rate for Payer: Aetna Commercial |
$1,020.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.55
|
| Rate for Payer: Cash Price |
$960.68
|
| Rate for Payer: Cofinity Commercial |
$840.60
|
| Rate for Payer: Cofinity Commercial |
$1,032.73
|
| Rate for Payer: Healthscope Commercial |
$1,080.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.72
|
| Rate for Payer: PHP Commercial |
$1,020.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.60
|
| Rate for Payer: Priority Health SBD |
$756.54
|
|
|
HC XR COLON HIGH DENSITY
|
Facility
|
OP
|
$1,200.85
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
32000146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,080.76 |
| Rate for Payer: Aetna Commercial |
$1,020.72
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$273.04
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$960.68
|
| Rate for Payer: Cash Price |
$960.68
|
| Rate for Payer: Cofinity Commercial |
$840.60
|
| Rate for Payer: Cofinity Commercial |
$1,032.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,080.76
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.72
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,020.72
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.60
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$756.54
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$215.78
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR COLON THERAPEUTIC FOR INTUS
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
32000147
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.26 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.70
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$400.29
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health SBD |
$360.26
|
|
|
HC XR COLON THERAPEUTIC FOR INTUS
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
32000147
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$261.45
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Cofinity Commercial |
$400.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$360.26
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$250.17
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
