|
HC XR ELBOW MIN 3 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
|
|
HC XR ELBOW MIN 3 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.17
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$193.74
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR ENDO RETROGRADE CHOLANGIOGR
|
Facility
|
IP
|
$544.76
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$381.33 |
| Max. Negotiated Rate |
$544.76 |
| Rate for Payer: Aetna Commercial |
$490.28
|
| Rate for Payer: ASR ASR |
$528.42
|
| Rate for Payer: BCBS Trust/PPO |
$422.35
|
| Rate for Payer: BCN Commercial |
$422.35
|
| Rate for Payer: Cash Price |
$435.81
|
| Rate for Payer: Cofinity Commercial |
$512.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.81
|
| Rate for Payer: Healthscope Commercial |
$544.76
|
| Rate for Payer: Healthscope Whirlpool |
$528.42
|
| Rate for Payer: Mclaren Commercial |
$490.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.39
|
|
|
HC XR ENDO RETROGRADE CHOLANGIOGR
|
Facility
|
OP
|
$544.76
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.90 |
| Max. Negotiated Rate |
$544.76 |
| Rate for Payer: Aetna Commercial |
$490.28
|
| Rate for Payer: ASR ASR |
$528.42
|
| Rate for Payer: BCBS Complete |
$217.90
|
| Rate for Payer: BCBS Trust/PPO |
$422.35
|
| Rate for Payer: BCN Commercial |
$422.35
|
| Rate for Payer: Cash Price |
$435.81
|
| Rate for Payer: Cofinity Commercial |
$512.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.81
|
| Rate for Payer: Healthscope Commercial |
$544.76
|
| Rate for Payer: Healthscope Whirlpool |
$528.42
|
| Rate for Payer: Mclaren Commercial |
$490.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.73
|
| Rate for Payer: Priority Health Narrow Network |
$386.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.39
|
|
|
HC XR ESOPHAGEAL DILATION
|
Facility
|
OP
|
$257.89
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.16 |
| Max. Negotiated Rate |
$257.89 |
| Rate for Payer: Aetna Commercial |
$232.10
|
| Rate for Payer: ASR ASR |
$250.15
|
| Rate for Payer: BCBS Complete |
$103.16
|
| Rate for Payer: BCBS Trust/PPO |
$199.94
|
| Rate for Payer: BCN Commercial |
$199.94
|
| Rate for Payer: Cash Price |
$206.31
|
| Rate for Payer: Cofinity Commercial |
$242.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.31
|
| Rate for Payer: Healthscope Commercial |
$257.89
|
| Rate for Payer: Healthscope Whirlpool |
$250.15
|
| Rate for Payer: Mclaren Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.68
|
| Rate for Payer: Priority Health Narrow Network |
$183.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.94
|
|
|
HC XR ESOPHAGEAL DILATION
|
Facility
|
IP
|
$257.89
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.52 |
| Max. Negotiated Rate |
$257.89 |
| Rate for Payer: Aetna Commercial |
$232.10
|
| Rate for Payer: ASR ASR |
$250.15
|
| Rate for Payer: BCBS Trust/PPO |
$199.94
|
| Rate for Payer: BCN Commercial |
$199.94
|
| Rate for Payer: Cash Price |
$206.31
|
| Rate for Payer: Cofinity Commercial |
$242.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.31
|
| Rate for Payer: Healthscope Commercial |
$257.89
|
| Rate for Payer: Healthscope Whirlpool |
$250.15
|
| Rate for Payer: Mclaren Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.94
|
|
|
HC XR ESOPHAGUS
|
Facility
|
IP
|
$630.27
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.19 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
|
|
HC XR ESOPHAGUS
|
Facility
|
OP
|
$630.27
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.83
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$214.26
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
IP
|
$481.37
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.96 |
| Max. Negotiated Rate |
$481.37 |
| Rate for Payer: Aetna Commercial |
$433.23
|
| Rate for Payer: ASR ASR |
$466.93
|
| Rate for Payer: BCBS Trust/PPO |
$373.21
|
| Rate for Payer: BCN Commercial |
$373.21
|
| Rate for Payer: Cash Price |
$385.10
|
| Rate for Payer: Cofinity Commercial |
$452.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.10
|
| Rate for Payer: Healthscope Commercial |
$481.37
|
| Rate for Payer: Healthscope Whirlpool |
$466.93
|
| Rate for Payer: Mclaren Commercial |
$433.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.61
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
OP
|
$481.37
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$481.37 |
| Rate for Payer: Aetna Commercial |
$433.23
|
| Rate for Payer: ASR ASR |
$466.93
|
| Rate for Payer: BCBS Complete |
$192.55
|
| Rate for Payer: BCBS Trust/PPO |
$373.21
|
| Rate for Payer: BCN Commercial |
$373.21
|
| Rate for Payer: Cash Price |
$385.10
|
| Rate for Payer: Cofinity Commercial |
$452.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.10
|
| Rate for Payer: Healthscope Commercial |
$481.37
|
| Rate for Payer: Healthscope Whirlpool |
$466.93
|
| Rate for Payer: Mclaren Commercial |
$433.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.05
|
| Rate for Payer: Priority Health Narrow Network |
$341.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.61
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
OP
|
$630.27
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.95
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$155.96
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
IP
|
$630.27
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.19 |
| Max. Negotiated Rate |
$630.27 |
| Rate for Payer: Aetna Commercial |
$567.24
|
| Rate for Payer: ASR ASR |
$611.36
|
| Rate for Payer: BCBS Trust/PPO |
$488.65
|
| Rate for Payer: BCN Commercial |
$488.65
|
| Rate for Payer: Cash Price |
$504.22
|
| Rate for Payer: Cofinity Commercial |
$592.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.22
|
| Rate for Payer: Healthscope Commercial |
$630.27
|
| Rate for Payer: Healthscope Whirlpool |
$611.36
|
| Rate for Payer: Mclaren Commercial |
$567.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.64
|
|
|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
OP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$450.67 |
| Rate for Payer: Aetna Commercial |
$405.60
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$437.15
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$349.40
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$423.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$450.67
|
| Rate for Payer: Healthscope Whirlpool |
$437.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$405.60
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.55
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$95.64
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.59
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
IP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.47 |
| Max. Negotiated Rate |
$450.67 |
| Rate for Payer: Aetna Commercial |
$405.60
|
| Rate for Payer: ASR ASR |
$437.15
|
| Rate for Payer: BCBS Trust/PPO |
$349.40
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$423.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.54
|
| Rate for Payer: Healthscope Commercial |
$450.67
|
| Rate for Payer: Healthscope Whirlpool |
$437.15
|
| Rate for Payer: Mclaren Commercial |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.59
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$450.67 |
| Rate for Payer: Aetna Commercial |
$405.60
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$437.15
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$349.40
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$423.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$450.67
|
| Rate for Payer: Healthscope Whirlpool |
$437.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$405.60
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.55
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$95.64
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.59
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$450.67
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.47 |
| Max. Negotiated Rate |
$450.67 |
| Rate for Payer: Aetna Commercial |
$405.60
|
| Rate for Payer: ASR ASR |
$437.15
|
| Rate for Payer: BCBS Trust/PPO |
$349.40
|
| Rate for Payer: BCN Commercial |
$349.40
|
| Rate for Payer: Cash Price |
$360.54
|
| Rate for Payer: Cofinity Commercial |
$423.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.54
|
| Rate for Payer: Healthscope Commercial |
$450.67
|
| Rate for Payer: Healthscope Whirlpool |
$437.15
|
| Rate for Payer: Mclaren Commercial |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$383.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.59
|
|
|
HC XR FACIAL BONES MIN 3 VW
|
Facility
|
IP
|
$340.12
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.08 |
| Max. Negotiated Rate |
$340.12 |
| Rate for Payer: Aetna Commercial |
$306.11
|
| Rate for Payer: ASR ASR |
$329.92
|
| Rate for Payer: BCBS Trust/PPO |
$263.70
|
| Rate for Payer: BCN Commercial |
$263.70
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$319.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Healthscope Commercial |
$340.12
|
| Rate for Payer: Healthscope Whirlpool |
$329.92
|
| Rate for Payer: Mclaren Commercial |
$306.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.31
|
|
|
HC XR FACIAL BONES MIN 3 VW
|
Facility
|
OP
|
$340.12
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$340.12 |
| Rate for Payer: Aetna Commercial |
$306.11
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$329.92
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$263.70
|
| Rate for Payer: BCN Commercial |
$263.70
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$319.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$340.12
|
| Rate for Payer: Healthscope Whirlpool |
$329.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$306.11
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.02
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$141.62
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.31
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR FEMUR 1 VIEW BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$173.95
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR FEMUR 1 VIEW BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$173.95
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
IP
|
$219.46
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna Commercial |
$197.51
|
| Rate for Payer: ASR ASR |
$212.88
|
| Rate for Payer: BCBS Trust/PPO |
$170.15
|
| Rate for Payer: BCN Commercial |
$170.15
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$206.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.57
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Healthscope Whirlpool |
$212.88
|
| Rate for Payer: Mclaren Commercial |
$197.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.12
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
OP
|
$219.46
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna Commercial |
$197.51
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$212.88
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$170.15
|
| Rate for Payer: BCN Commercial |
$170.15
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$206.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Healthscope Whirlpool |
$212.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$197.51
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.54
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.64
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$82.91
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.12
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR FINGERS MIN 2 VW
|
Facility
|
IP
|
$190.24
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.17 |
| Max. Negotiated Rate |
$190.24 |
| Rate for Payer: Aetna Commercial |
$171.22
|
| Rate for Payer: ASR ASR |
$184.53
|
| Rate for Payer: BCBS Trust/PPO |
$147.49
|
| Rate for Payer: BCN Commercial |
$147.49
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$178.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.19
|
| Rate for Payer: Healthscope Commercial |
$190.24
|
| Rate for Payer: Healthscope Whirlpool |
$184.53
|
| Rate for Payer: Mclaren Commercial |
$171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.41
|
|
