|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
IP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.93 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.12
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health SBD |
$68.93
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
OP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.12
|
| 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 |
$49.65
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| 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 |
$93.00
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$93.00
|
| 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 |
$76.59
|
| 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 |
$68.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
IP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.10
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health SBD |
$367.43
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
OP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.29 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.10
|
| Rate for Payer: BCBS Complete |
$233.29
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health SBD |
$367.43
|
| Rate for Payer: UHC Core |
$431.59
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$624.82 |
| Max. Negotiated Rate |
$892.59 |
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.65
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$694.24
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health SBD |
$624.82
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,221.16 |
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$117.49
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$694.24
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.16
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.93
|
| Rate for Payer: Priority Health SBD |
$624.82
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$110.02
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
OP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.43 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| 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 |
$37.50
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| 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 |
$113.31
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| 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 |
$83.99
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$31.43
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health SBD |
$83.99
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.47
|
| 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 |
$219.53
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$840.50
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| 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 |
$1,020.61
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| 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 |
$840.50
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$756.45
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$756.45 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.47
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Cofinity Commercial |
$840.50
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.61
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.50
|
| Rate for Payer: Priority Health SBD |
$756.45
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$240.19 |
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.47
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$186.82
|
| Rate for Payer: Cofinity Commercial |
$229.52
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.85
|
| Rate for Payer: PHP Commercial |
$226.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.82
|
| Rate for Payer: Priority Health SBD |
$168.13
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.47
|
| 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 |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$186.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| 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 |
$226.85
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$226.85
|
| 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 |
$186.82
|
| 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 |
$168.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
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 ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.15 |
| 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) |
$51.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$47.15
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| 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 |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$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 OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
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 OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health SBD |
$189.26
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$34.75
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$189.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$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 PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.84
|
| 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 |
$32.54
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Cofinity Commercial |
$203.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| 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 |
$246.95
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$246.95
|
| 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 |
$203.37
|
| 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 |
$183.03
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$261.48 |
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.84
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$203.37
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.95
|
| Rate for Payer: PHP Commercial |
$246.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.37
|
| Rate for Payer: Priority Health SBD |
$183.03
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$50.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$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 |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$41.59
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health SBD |
$630.48
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| 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 |
$187.54
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| 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 |
$850.65
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$850.65
|
| 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 |
$700.53
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$630.48
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$132.61
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,300.78
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$1,170.70 |
| Rate for Payer: Aetna Commercial |
$1,105.66
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$910.55
|
| Rate for Payer: Cofinity Commercial |
$1,118.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,170.70
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,105.66
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$819.49
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
