|
HC XR SHOULDER BIL 1 VW
|
Facility
|
IP
|
$171.64
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$154.48 |
| Rate for Payer: Aetna Commercial |
$145.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.57
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cofinity Commercial |
$147.61
|
| Rate for Payer: Cofinity Commercial |
$120.15
|
| Rate for Payer: Healthscope Commercial |
$154.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.89
|
| Rate for Payer: PHP Commercial |
$145.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.15
|
| Rate for Payer: Priority Health SBD |
$108.13
|
|
|
HC XR SHOULDER BIL 1 VW
|
Facility
|
OP
|
$171.64
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$145.89
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.57
|
| 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 |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cofinity Commercial |
$120.15
|
| Rate for Payer: Cofinity Commercial |
$147.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$154.48
|
| 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 |
$145.89
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$145.89
|
| 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 |
$120.15
|
| 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 |
$108.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
OP
|
$442.79
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna Commercial |
$376.37
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.81
|
| 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 |
$42.47
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$309.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$398.51
|
| 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 |
$376.37
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$376.37
|
| 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 |
$309.95
|
| 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 |
$278.96
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
IP
|
$442.79
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna Commercial |
$376.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.81
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cofinity Commercial |
$309.95
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$398.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.37
|
| Rate for Payer: PHP Commercial |
$376.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.95
|
| Rate for Payer: Priority Health SBD |
$278.96
|
|
|
HC XR SHOULDER MIN 2 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$42.47
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR SHOULDER MIN 2 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC XR SINUSES LESS THAN 3 VW
|
Facility
|
OP
|
$200.23
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$170.20
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.15
|
| 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 |
$160.18
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$140.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$180.21
|
| 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 |
$170.20
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$170.20
|
| 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 |
$140.16
|
| 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 |
$126.14
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR SINUSES LESS THAN 3 VW
|
Facility
|
IP
|
$200.23
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$180.21 |
| Rate for Payer: Aetna Commercial |
$170.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.15
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.16
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Healthscope Commercial |
$180.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.20
|
| Rate for Payer: PHP Commercial |
$170.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.16
|
| Rate for Payer: Priority Health SBD |
$126.14
|
|
|
HC XR SINUSES MIN 3 VW
|
Facility
|
IP
|
$350.63
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.90 |
| Max. Negotiated Rate |
$315.57 |
| Rate for Payer: Aetna Commercial |
$298.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.91
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cofinity Commercial |
$245.44
|
| Rate for Payer: Cofinity Commercial |
$301.54
|
| Rate for Payer: Healthscope Commercial |
$315.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.04
|
| Rate for Payer: PHP Commercial |
$298.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.44
|
| Rate for Payer: Priority Health SBD |
$220.90
|
|
|
HC XR SINUSES MIN 3 VW
|
Facility
|
OP
|
$350.63
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$315.57 |
| Rate for Payer: Aetna Commercial |
$298.04
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.91
|
| 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 |
$45.23
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cofinity Commercial |
$301.54
|
| Rate for Payer: Cofinity Commercial |
$245.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$315.57
|
| 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 |
$298.04
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$298.04
|
| 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 |
$245.44
|
| 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 |
$220.90
|
| 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 SINUS TRACT FISTULA ABSCESS
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$240.09
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC XR SINUS TRACT FISTULA ABSCESS
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.09 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$240.09
|
|
|
HC XR SKULL LESS THAN 4 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
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 SKULL LESS THAN 4 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| 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 |
$45.23
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| 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 |
$297.81
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$297.81
|
| 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 |
$245.26
|
| 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 |
$220.73
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$35.36
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR SKULL MIN 4 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
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 SKULL MIN 4 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.88 |
| 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 |
$51.85
|
| 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) |
$48.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR SMALL BOWEL
|
Facility
|
OP
|
$600.55
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$540.50 |
| Rate for Payer: Aetna Commercial |
$510.47
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.36
|
| 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 |
$142.31
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cofinity Commercial |
$420.38
|
| Rate for Payer: Cofinity Commercial |
$516.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$540.50
|
| 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 |
$510.47
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$510.47
|
| 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 |
$420.38
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$378.35
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$119.52
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR SMALL BOWEL
|
Facility
|
IP
|
$600.55
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$378.35 |
| Max. Negotiated Rate |
$540.50 |
| Rate for Payer: Aetna Commercial |
$510.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.36
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cofinity Commercial |
$420.38
|
| Rate for Payer: Cofinity Commercial |
$516.47
|
| Rate for Payer: Healthscope Commercial |
$540.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.47
|
| Rate for Payer: PHP Commercial |
$510.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.38
|
| Rate for Payer: Priority Health SBD |
$378.35
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
IP
|
$278.77
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.63 |
| Max. Negotiated Rate |
$250.89 |
| Rate for Payer: Aetna Commercial |
$236.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.20
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$239.74
|
| Rate for Payer: Healthscope Commercial |
$250.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.95
|
| Rate for Payer: PHP Commercial |
$236.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: Priority Health SBD |
$175.63
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
OP
|
$278.77
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$250.89 |
| Rate for Payer: Aetna Commercial |
$236.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.20
|
| Rate for Payer: BCBS Complete |
$111.51
|
| Rate for Payer: BCBS Trust/PPO |
$83.84
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$239.74
|
| Rate for Payer: Healthscope Commercial |
$250.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.95
|
| Rate for Payer: PHP Commercial |
$236.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: Priority Health SBD |
$175.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.97
|
| Rate for Payer: UHC Exchange |
$80.88
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| 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 |
$527.88
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| 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 |
$680.45
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$680.45
|
| 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 |
$560.37
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$504.33
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$355.93
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health SBD |
$504.33
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
OP
|
$304.45
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.89
|
| 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 |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$261.83
|
| Rate for Payer: Cofinity Commercial |
$213.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| 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 |
$258.78
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$258.78
|
| 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 |
$213.12
|
| 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 |
$191.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$30.78
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
IP
|
$304.45
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.89
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$261.83
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.78
|
| Rate for Payer: PHP Commercial |
$258.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.12
|
| Rate for Payer: Priority Health SBD |
$191.80
|
|
|
HC XR SPECIMEN X-RAY
|
Facility
|
IP
|
$206.67
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$175.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.34
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cofinity Commercial |
$144.67
|
| Rate for Payer: Cofinity Commercial |
$177.74
|
| Rate for Payer: Healthscope Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.67
|
| Rate for Payer: PHP Commercial |
$175.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.67
|
| Rate for Payer: Priority Health SBD |
$130.20
|
|
