|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$68.14
|
| Rate for Payer: BCN Commercial |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$249.78
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.71
|
| Rate for Payer: UHC Core |
$206.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$155.82
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE LUMBAR MIN 4 VW
|
Facility
|
IP
|
$446.38
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
32000045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.22 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PHP Commercial |
$379.42
|
| Rate for Payer: Priority Health SBD |
$281.22
|
|
|
HC XR SPINE LUMBAR MIN 4 VW
|
Facility
|
OP
|
$446.38
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
32000045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$89.35
|
| Rate for Payer: BCN Commercial |
$89.35
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$379.42
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$281.22
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.15
|
| Rate for Payer: UHC Core |
$232.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$175.43
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE LUMB COMP W BEND MIN 6 VW
|
Facility
|
OP
|
$574.54
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
32000046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$517.09 |
| Rate for Payer: Aetna Commercial |
$488.36
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$105.99
|
| Rate for Payer: BCN Commercial |
$105.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$459.63
|
| Rate for Payer: Cash Price |
$459.63
|
| Rate for Payer: Cofinity Advantage |
$402.18
|
| Rate for Payer: Cofinity Commercial |
$494.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$517.09
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.36
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.90
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$488.36
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$361.96
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.45
|
| Rate for Payer: UHC Core |
$299.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$225.79
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE LUMB COMP W BEND MIN 6 VW
|
Facility
|
IP
|
$574.54
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
32000046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.96 |
| Max. Negotiated Rate |
$517.09 |
| Rate for Payer: Aetna Commercial |
$488.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.45
|
| Rate for Payer: Cash Price |
$459.63
|
| Rate for Payer: Cofinity Advantage |
$402.18
|
| Rate for Payer: Cofinity Commercial |
$494.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.63
|
| Rate for Payer: Healthscope Commercial |
$517.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.90
|
| Rate for Payer: PHP Commercial |
$488.36
|
| Rate for Payer: Priority Health SBD |
$361.96
|
|
|
HC XR SPINE SINGLE VW
|
Facility
|
OP
|
$191.46
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.86 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$37.86
|
| Rate for Payer: BCN Commercial |
$37.86
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$153.17
|
| Rate for Payer: Cash Price |
$153.17
|
| Rate for Payer: Cofinity Advantage |
$134.02
|
| Rate for Payer: Cofinity Commercial |
$164.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$172.31
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.74
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.59
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$162.74
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$120.62
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.45
|
| Rate for Payer: UHC Core |
$99.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$75.24
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR SPINE SINGLE VW
|
Facility
|
IP
|
$191.46
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.62 |
| Max. Negotiated Rate |
$172.31 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.45
|
| Rate for Payer: Cash Price |
$153.17
|
| Rate for Payer: Cofinity Advantage |
$134.02
|
| Rate for Payer: Cofinity Commercial |
$164.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.17
|
| Rate for Payer: Healthscope Commercial |
$172.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.59
|
| Rate for Payer: PHP Commercial |
$162.74
|
| Rate for Payer: Priority Health SBD |
$120.62
|
|
|
HC XR SPINE THORACIC 2 VW
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
32000039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.65 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health SBD |
$229.65
|
|
|
HC XR SPINE THORACIC 2 VW
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
32000039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$53.00
|
| Rate for Payer: BCN Commercial |
$53.00
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.94
|
| Rate for Payer: UHC Core |
$189.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$143.26
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE THORACIC 3 VW
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$65.11
|
| Rate for Payer: BCN Commercial |
$65.11
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Advantage |
$291.45
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$262.31
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.63
|
| Rate for Payer: UHC Core |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$163.63
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE THORACIC 3 VW
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.63
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Advantage |
$291.45
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: Priority Health SBD |
$262.31
|
|
|
HC XR SPINE THORACIC 4 VW OR MORE
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.98 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: Priority Health SBD |
$327.98
|
|
|
HC XR SPINE THORACIC 4 VW OR MORE
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$74.96
|
| Rate for Payer: BCN Commercial |
$74.96
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$327.98
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.39
|
| Rate for Payer: UHC Core |
$271.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$204.60
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SPINE THORACOLUMBAR 2 VW
|
Facility
|
IP
|
$390.58
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.07 |
| Max. Negotiated Rate |
$351.52 |
| Rate for Payer: Aetna Commercial |
$331.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.88
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cofinity Advantage |
$273.41
|
| Rate for Payer: Cofinity Commercial |
$335.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.46
|
| Rate for Payer: Healthscope Commercial |
$351.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.94
|
| Rate for Payer: PHP Commercial |
$331.99
|
| Rate for Payer: Priority Health SBD |
$246.07
|
|
|
HC XR SPINE THORACOLUMBAR 2 VW
|
Facility
|
OP
|
$390.58
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$351.52 |
| Rate for Payer: Aetna Commercial |
$331.99
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$56.03
|
| Rate for Payer: BCN Commercial |
$56.03
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cofinity Advantage |
$273.41
|
| Rate for Payer: Cofinity Commercial |
$335.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$351.52
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.99
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.94
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$331.99
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$246.07
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.88
|
| Rate for Payer: UHC Core |
$203.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$153.50
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR STERNOCLAV JTS MIN 3 VW
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Advantage |
$218.79
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: Priority Health SBD |
$196.91
|
|
|
HC XR STERNOCLAV JTS MIN 3 VW
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$69.66
|
| Rate for Payer: BCN Commercial |
$69.66
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Advantage |
$218.79
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.16
|
| Rate for Payer: UHC Core |
$162.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$122.84
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR STERNUM MIN 2 VW
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$54.52
|
| Rate for Payer: BCN Commercial |
$54.52
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.94
|
| Rate for Payer: UHC Core |
$189.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$143.26
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR STERNUM MIN 2 VW
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.65 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health SBD |
$229.65
|
|
|
HC XR SWALLOWING FUNC W CINE VIDE
|
Facility
|
IP
|
$593.63
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$373.99 |
| Max. Negotiated Rate |
$534.27 |
| Rate for Payer: Aetna Commercial |
$504.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.86
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Advantage |
$415.54
|
| Rate for Payer: Cofinity Commercial |
$510.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Healthscope Commercial |
$534.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: PHP Commercial |
$504.59
|
| Rate for Payer: Priority Health SBD |
$373.99
|
|
|
HC XR SWALLOWING FUNC W CINE VIDE
|
Facility
|
OP
|
$593.63
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$565.19 |
| Rate for Payer: Aetna Commercial |
$504.59
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$219.57
|
| Rate for Payer: BCN Commercial |
$219.57
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Advantage |
$415.54
|
| Rate for Payer: Cofinity Commercial |
$510.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$534.27
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.59
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$504.59
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$373.99
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.86
|
| Rate for Payer: UHC Core |
$309.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$233.30
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
IP
|
$228.33
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.41
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Advantage |
$159.83
|
| Rate for Payer: Cofinity Commercial |
$196.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Healthscope Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: PHP Commercial |
$194.08
|
| Rate for Payer: Priority Health SBD |
$143.85
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
OP
|
$228.33
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.73 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Advantage |
$159.83
|
| Rate for Payer: Cofinity Commercial |
$196.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$205.50
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$194.08
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$143.85
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.41
|
| Rate for Payer: UHC Core |
$118.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$89.73
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
IP
|
$172.67
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$155.40 |
| Rate for Payer: Aetna Commercial |
$146.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.24
|
| Rate for Payer: Cash Price |
$138.14
|
| Rate for Payer: Cofinity Advantage |
$120.87
|
| Rate for Payer: Cofinity Commercial |
$148.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.14
|
| Rate for Payer: Healthscope Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.50
|
| Rate for Payer: PHP Commercial |
$146.77
|
| Rate for Payer: Priority Health SBD |
$108.78
|
|
