|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
IP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$383.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.94
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$315.47
|
| Rate for Payer: Cofinity Commercial |
$387.58
|
| Rate for Payer: Healthscope Commercial |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: PHP Commercial |
$383.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: Priority Health SBD |
$283.92
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$383.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.94
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$315.47
|
| Rate for Payer: Cofinity Commercial |
$387.58
|
| Rate for Payer: Healthscope Commercial |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: PHP Commercial |
$383.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: Priority Health SBD |
$283.92
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$383.07
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.94
|
| 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 |
$39.72
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$387.58
|
| Rate for Payer: Cofinity Commercial |
$315.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$405.60
|
| 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 |
$383.07
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$383.07
|
| 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 |
$315.47
|
| 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 |
$283.92
|
| 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 FACIAL BONES MIN 3 VW
|
Facility
|
IP
|
$340.12
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.08
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PHP Commercial |
$289.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health SBD |
$214.28
|
|
|
HC XR FACIAL BONES MIN 3 VW
|
Facility
|
OP
|
$340.12
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.08
|
| 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 |
$57.36
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Cofinity Commercial |
$238.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| 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 |
$289.10
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$289.10
|
| 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 |
$238.08
|
| 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 |
$214.28
|
| 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 FEMUR 1 VIEW BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| 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 |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| 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 |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$208.25
|
| 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 |
$171.50
|
| 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 |
$154.35
|
| 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 FEMUR 1 VIEW BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| 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 |
$44.68
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| 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 |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$208.25
|
| 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 |
$171.50
|
| 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 |
$154.35
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$35.04
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
OP
|
$219.46
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$186.54
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.65
|
| 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 |
$51.85
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$197.51
|
| 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 |
$186.54
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$186.54
|
| 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 |
$153.62
|
| 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 |
$138.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
IP
|
$219.46
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.26 |
| Max. Negotiated Rate |
$197.51 |
| Rate for Payer: Aetna Commercial |
$186.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.65
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.74
|
| Rate for Payer: Healthscope Commercial |
$197.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.54
|
| Rate for Payer: PHP Commercial |
$186.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health SBD |
$138.26
|
|
|
HC XR FINGERS MIN 2 VW
|
Facility
|
OP
|
$190.24
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.66
|
| 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 |
$51.85
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Cofinity Commercial |
$133.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| 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 |
$161.70
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$161.70
|
| 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 |
$133.17
|
| 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 |
$119.85
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FINGERS MIN 2 VW
|
Facility
|
IP
|
$190.24
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$171.22 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.66
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.70
|
| Rate for Payer: PHP Commercial |
$161.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health SBD |
$119.85
|
|
|
HC XR FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
32000246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.50
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health SBD |
$182.70
|
|
|
HC XR FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
32000246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.95 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.50
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.93
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$203.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health SBD |
$182.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.34
|
| Rate for Payer: UHC Exchange |
$113.95
|
|
|
HC XR FOOT 1 VW
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.98
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health SBD |
$180.26
|
|
|
HC XR FOOT 1 VW
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.98
|
| 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 |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| 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 |
$243.20
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$243.20
|
| 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 |
$200.28
|
| 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 |
$180.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FOOT 2 VIEWS
|
Facility
|
OP
|
$250.45
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.79
|
| 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 |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| 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 |
$212.88
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$212.88
|
| 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 |
$175.32
|
| 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 |
$157.78
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FOOT 2 VIEWS
|
Facility
|
IP
|
$250.45
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.79
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.88
|
| Rate for Payer: PHP Commercial |
$212.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.32
|
| Rate for Payer: Priority Health SBD |
$157.78
|
|
|
HC XR FOOT 2 VIEWS BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| 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 |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| 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 |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$208.25
|
| 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 |
$171.50
|
| 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 |
$154.35
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR FOOT 2 VIEWS BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
|
|
HC XR FOOT 3 VIEWS
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
32000126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.73 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
|
|
HC XR FOOT 3 VIEWS
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
32000126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| 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 |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| 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 |
$297.81
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$297.81
|
| 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 |
$245.26
|
| 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 |
$220.73
|
| 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 FOOT BIL 2 VIEWS
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.98
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health SBD |
$180.26
|
|
|
HC XR FOOT BIL 2 VIEWS
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.98
|
| 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 |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| 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 |
$243.20
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$243.20
|
| 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 |
$200.28
|
| 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 |
$180.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
