|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
OP
|
$172.67
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.86 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$146.77
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.24
|
| 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 |
$138.14
|
| 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: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$155.40
|
| 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 |
$146.77
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.50
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$146.77
|
| 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 |
$108.78
|
| 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) |
$112.24
|
| Rate for Payer: UHC Core |
$89.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$67.86
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR TIB FIB 2 VIEWS
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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 TIB FIB 2 VIEWS
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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 TIB FIB BIL 2 VW
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
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 TIB FIB BIL 2 VW
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| 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 |
$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 |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| 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 |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$337.01
|
| 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 |
$249.78
|
| 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) |
$257.71
|
| Rate for Payer: UHC Core |
$206.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$155.82
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR TMJ COMPLETE BIL
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.63
|
| 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 |
$94.65
|
| Rate for Payer: BCN Commercial |
$94.65
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| 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 |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| 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 |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$353.91
|
| 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 |
$262.31
|
| 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) |
$270.63
|
| Rate for Payer: UHC Core |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$163.63
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR TMJ COMPLETE BIL
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ LTD
|
Facility
|
OP
|
$113.83
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.99
|
| 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 |
$58.30
|
| Rate for Payer: BCN Commercial |
$58.30
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cofinity Advantage |
$79.68
|
| Rate for Payer: Cofinity Commercial |
$97.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$102.45
|
| 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 |
$96.76
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.37
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$96.76
|
| 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 |
$71.71
|
| 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) |
$73.99
|
| Rate for Payer: UHC Core |
$59.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$44.74
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR TMJ LTD
|
Facility
|
IP
|
$113.83
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.99
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cofinity Advantage |
$79.68
|
| Rate for Payer: Cofinity Commercial |
$97.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.06
|
| Rate for Payer: Healthscope Commercial |
$102.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.37
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health SBD |
$71.71
|
|
|
HC XR TOES BIL MIN 2 VIEWS
|
Facility
|
IP
|
$228.33
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
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 TOES BIL MIN 2 VIEWS
|
Facility
|
OP
|
$228.33
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.41
|
| 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 |
$51.49
|
| Rate for Payer: BCN Commercial |
$51.49
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| 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 |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$205.50
|
| 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 |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$194.08
|
| 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 |
$143.85
|
| 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) |
$148.41
|
| Rate for Payer: UHC Core |
$118.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$89.73
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
OP
|
$197.92
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$168.23
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.65
|
| 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 |
$51.49
|
| Rate for Payer: BCN Commercial |
$51.49
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cofinity Advantage |
$138.54
|
| Rate for Payer: Cofinity Commercial |
$170.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$178.13
|
| 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 |
$168.23
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.44
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$168.23
|
| 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 |
$124.69
|
| 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) |
$128.65
|
| Rate for Payer: UHC Core |
$103.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$77.78
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
IP
|
$197.92
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.69 |
| Max. Negotiated Rate |
$178.13 |
| Rate for Payer: Aetna Commercial |
$168.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.65
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cofinity Advantage |
$138.54
|
| Rate for Payer: Cofinity Commercial |
$170.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.34
|
| Rate for Payer: Healthscope Commercial |
$178.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.44
|
| Rate for Payer: PHP Commercial |
$168.23
|
| Rate for Payer: Priority Health SBD |
$124.69
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
IP
|
$315.25
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.61 |
| Max. Negotiated Rate |
$283.73 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.91
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cofinity Advantage |
$220.68
|
| Rate for Payer: Cofinity Commercial |
$271.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.20
|
| Rate for Payer: Healthscope Commercial |
$283.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.44
|
| Rate for Payer: PHP Commercial |
$267.96
|
| Rate for Payer: Priority Health SBD |
$198.61
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
OP
|
$315.25
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$565.19 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.91
|
| 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 |
$187.76
|
| Rate for Payer: BCN Commercial |
$187.76
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cofinity Advantage |
$220.68
|
| Rate for Payer: Cofinity Commercial |
$271.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$283.73
|
| 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 |
$267.96
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.44
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$267.96
|
| 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 |
$198.61
|
| 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) |
$204.91
|
| Rate for Payer: UHC Core |
$164.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$123.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR UPPER GI
|
Facility
|
OP
|
$595.21
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$565.19 |
| Rate for Payer: Aetna Commercial |
$505.93
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.89
|
| 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 |
$214.28
|
| Rate for Payer: BCN Commercial |
$214.28
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cofinity Advantage |
$416.65
|
| Rate for Payer: Cofinity Commercial |
$511.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$535.69
|
| 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 |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.41
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$505.93
|
| 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 |
$374.98
|
| 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) |
$386.89
|
| Rate for Payer: UHC Core |
$310.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$233.92
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR UPPER GI
|
Facility
|
IP
|
$595.21
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.98 |
| Max. Negotiated Rate |
$535.69 |
| Rate for Payer: Aetna Commercial |
$505.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.89
|
| Rate for Payer: Cash Price |
$476.17
|
| Rate for Payer: Cofinity Advantage |
$416.65
|
| Rate for Payer: Cofinity Commercial |
$511.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.17
|
| Rate for Payer: Healthscope Commercial |
$535.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.41
|
| Rate for Payer: PHP Commercial |
$505.93
|
| Rate for Payer: Priority Health SBD |
$374.98
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
IP
|
$576.94
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.47 |
| Max. Negotiated Rate |
$519.25 |
| Rate for Payer: Aetna Commercial |
$490.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.01
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cofinity Advantage |
$403.86
|
| Rate for Payer: Cofinity Commercial |
$496.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.55
|
| Rate for Payer: Healthscope Commercial |
$519.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.70
|
| Rate for Payer: PHP Commercial |
$490.40
|
| Rate for Payer: Priority Health SBD |
$363.47
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
OP
|
$576.94
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$490.40
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.01
|
| 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: BCBS Trust/PPO |
$343.63
|
| Rate for Payer: BCN Commercial |
$343.63
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cash Price |
$461.55
|
| Rate for Payer: Cofinity Advantage |
$403.86
|
| Rate for Payer: Cofinity Commercial |
$496.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$519.25
|
| 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 |
$490.40
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.70
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$490.40
|
| 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 |
$363.47
|
| 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) |
$375.01
|
| Rate for Payer: UHC Core |
$300.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$226.74
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
OP
|
$808.74
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$727.87 |
| Rate for Payer: Aetna Commercial |
$687.43
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.68
|
| 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 |
$263.48
|
| Rate for Payer: BCN Commercial |
$263.48
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cofinity Advantage |
$566.12
|
| Rate for Payer: Cofinity Commercial |
$695.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$727.87
|
| 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 |
$687.43
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.55
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$687.43
|
| 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 |
$509.51
|
| 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) |
$525.68
|
| Rate for Payer: UHC Core |
$421.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$317.83
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
IP
|
$808.74
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$509.51 |
| Max. Negotiated Rate |
$727.87 |
| Rate for Payer: Aetna Commercial |
$687.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.68
|
| Rate for Payer: Cash Price |
$646.99
|
| Rate for Payer: Cofinity Advantage |
$566.12
|
| Rate for Payer: Cofinity Commercial |
$695.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.99
|
| Rate for Payer: Healthscope Commercial |
$727.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.55
|
| Rate for Payer: PHP Commercial |
$687.43
|
| Rate for Payer: Priority Health SBD |
$509.51
|
|
|
HC XR WRIST 2 VW
|
Facility
|
OP
|
$260.57
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$221.48
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.37
|
| 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 |
$58.30
|
| Rate for Payer: BCN Commercial |
$58.30
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cofinity Advantage |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$224.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$234.51
|
| 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 |
$221.48
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.43
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$221.48
|
| 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 |
$164.16
|
| 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) |
$169.37
|
| Rate for Payer: UHC Core |
$135.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$102.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST 2 VW
|
Facility
|
IP
|
$260.57
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$234.51 |
| Rate for Payer: Aetna Commercial |
$221.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.37
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cofinity Advantage |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$224.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.46
|
| Rate for Payer: Healthscope Commercial |
$234.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.43
|
| Rate for Payer: PHP Commercial |
$221.48
|
| Rate for Payer: Priority Health SBD |
$164.16
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| 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 |
$58.30
|
| Rate for Payer: BCN Commercial |
$58.30
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| 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 |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$253.03
|
| 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 |
$187.54
|
| 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) |
$193.49
|
| Rate for Payer: UHC Core |
$155.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$116.99
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.54 |
| Max. Negotiated Rate |
$267.91 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: Priority Health SBD |
$187.54
|
|
