|
HC XR CYSTOGRAM MIN 3 VW
|
Facility
|
OP
|
$439.05
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$980.43 |
| Rate for Payer: Aetna Commercial |
$373.19
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$351.24
|
| Rate for Payer: Cash Price |
$351.24
|
| Rate for Payer: Cofinity Commercial |
$377.58
|
| Rate for Payer: Cofinity Commercial |
$307.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$395.14
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.19
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$373.19
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.38
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$276.60
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$324.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$324.90
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC XR CYSTOGRAM MIN 3 VW
|
Facility
|
IP
|
$439.05
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.60 |
| Max. Negotiated Rate |
$395.14 |
| Rate for Payer: Aetna Commercial |
$373.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.38
|
| Rate for Payer: Cash Price |
$351.24
|
| Rate for Payer: Cofinity Commercial |
$307.33
|
| Rate for Payer: Cofinity Commercial |
$377.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.24
|
| Rate for Payer: Healthscope Commercial |
$395.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.19
|
| Rate for Payer: PHP Commercial |
$373.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.38
|
| Rate for Payer: Priority Health SBD |
$276.60
|
|
|
HC XR CYSTOGRAM VOIDING
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$321.55
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$377.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$377.69
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC XR CYSTOGRAM VOIDING
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.55 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health SBD |
$321.55
|
|
|
HC XR DEFECOGRAPHY 4 WAY
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
32000164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$980.43 |
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$514.42
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$604.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$604.24
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC XR DEFECOGRAPHY 4 WAY
|
Facility
|
IP
|
$816.54
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
32000164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.42 |
| Max. Negotiated Rate |
$734.89 |
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.75
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health SBD |
$514.42
|
|
|
HC XR ELBOW 2 BIL VW
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC XR ELBOW 2 BIL VW
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$287.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$287.65
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ELBOW 2 VW
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.15 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
|
HC XR ELBOW 2 VW
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$264.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$264.46
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ELBOW BIL 3 VW
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$287.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$287.65
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ELBOW BIL 3 VW
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC XR ELBOW MIN 3 VW
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.15 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
|
HC XR ELBOW MIN 3 VW
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$264.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$264.46
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ENDO RETROGRADE CHOLANGIOGR
|
Facility
|
IP
|
$555.66
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$500.09 |
| Rate for Payer: Aetna Commercial |
$472.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.18
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cofinity Commercial |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$477.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.53
|
| Rate for Payer: Healthscope Commercial |
$500.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.31
|
| Rate for Payer: PHP Commercial |
$472.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.18
|
| Rate for Payer: Priority Health SBD |
$350.07
|
|
|
HC XR ENDO RETROGRADE CHOLANGIOGR
|
Facility
|
OP
|
$555.66
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.26 |
| Max. Negotiated Rate |
$500.09 |
| Rate for Payer: Aetna Commercial |
$472.31
|
| Rate for Payer: Aetna Medicare |
$277.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.18
|
| Rate for Payer: BCBS Complete |
$222.26
|
| Rate for Payer: Cash Price |
$444.53
|
| Rate for Payer: Cofinity Commercial |
$388.96
|
| Rate for Payer: Cofinity Commercial |
$477.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.53
|
| Rate for Payer: Healthscope Commercial |
$500.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.31
|
| Rate for Payer: PHP Commercial |
$472.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.18
|
| Rate for Payer: Priority Health SBD |
$350.07
|
| Rate for Payer: UHC Core |
$411.19
|
| Rate for Payer: UHC Exchange |
$411.19
|
|
|
HC XR ESOPHAGEAL DILATION
|
Facility
|
IP
|
$263.05
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.72 |
| Max. Negotiated Rate |
$236.75 |
| Rate for Payer: Aetna Commercial |
$223.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: Cash Price |
$210.44
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.44
|
| Rate for Payer: Healthscope Commercial |
$236.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.59
|
| Rate for Payer: PHP Commercial |
$223.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
|
|
HC XR ESOPHAGEAL DILATION
|
Facility
|
OP
|
$263.05
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$236.75 |
| Rate for Payer: Aetna Commercial |
$223.59
|
| Rate for Payer: Aetna Medicare |
$131.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.98
|
| Rate for Payer: BCBS Complete |
$105.22
|
| Rate for Payer: Cash Price |
$210.44
|
| Rate for Payer: Cofinity Commercial |
$184.13
|
| Rate for Payer: Cofinity Commercial |
$226.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.44
|
| Rate for Payer: Healthscope Commercial |
$236.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.59
|
| Rate for Payer: PHP Commercial |
$223.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health SBD |
$165.72
|
| Rate for Payer: UHC Core |
$194.66
|
| Rate for Payer: UHC Exchange |
$194.66
|
|
|
HC XR ESOPHAGUS
|
Facility
|
IP
|
$642.88
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$405.01 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.87
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$450.02
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health SBD |
$405.01
|
|
|
HC XR ESOPHAGUS
|
Facility
|
OP
|
$642.88
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Cofinity Commercial |
$450.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$405.01
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$475.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$475.73
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$309.33 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.15
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$343.70
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.35
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health SBD |
$309.33
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna Medicare |
$245.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.15
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$343.70
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.35
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health SBD |
$309.33
|
| Rate for Payer: UHC Core |
$363.34
|
| Rate for Payer: UHC Exchange |
$363.34
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
IP
|
$642.88
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$405.01 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.87
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$450.02
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health SBD |
$405.01
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
OP
|
$642.88
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Cofinity Commercial |
$450.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$405.01
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$475.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$475.73
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
IP
|
$459.68
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$413.71 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.79
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$321.78
|
| Rate for Payer: Cofinity Commercial |
$395.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.74
|
| Rate for Payer: Healthscope Commercial |
$413.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.73
|
| Rate for Payer: PHP Commercial |
$390.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.79
|
| Rate for Payer: Priority Health SBD |
$289.60
|
|
