|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
IP
|
$141.58
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.19 |
| Max. Negotiated Rate |
$141.58 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: ASR ASR |
$137.33
|
| Rate for Payer: BCBS Trust/PPO |
$116.27
|
| Rate for Payer: BCN Commercial |
$116.27
|
| Rate for Payer: Cash Price |
$113.26
|
| Rate for Payer: Cofinity Commercial |
$133.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.26
|
| Rate for Payer: Healthscope Commercial |
$137.33
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Mclaren Commercial |
$127.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.34
|
| Rate for Payer: Nomi Health Commercial |
$116.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.59
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
OP
|
$141.58
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$204.59 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$137.33
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$116.73
|
| Rate for Payer: BCN Commercial |
$116.73
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$113.26
|
| Rate for Payer: Cash Price |
$113.26
|
| Rate for Payer: Cofinity Commercial |
$133.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$137.33
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$127.42
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.34
|
| Rate for Payer: Nomi Health Commercial |
$116.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.19
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$204.59
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$163.67
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
IP
|
$113.83
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.37 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$102.45
|
| Rate for Payer: ASR ASR |
$110.42
|
| Rate for Payer: BCBS Trust/PPO |
$93.48
|
| Rate for Payer: BCN Commercial |
$93.48
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cofinity Commercial |
$107.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.06
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Healthscope Whirlpool |
$113.83
|
| Rate for Payer: Mclaren Commercial |
$102.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Nomi Health Commercial |
$93.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.17
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
OP
|
$113.83
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$161.46 |
| Rate for Payer: Aetna Commercial |
$102.45
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$110.42
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$93.85
|
| Rate for Payer: BCN Commercial |
$93.85
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cofinity Commercial |
$107.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Healthscope Whirlpool |
$113.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$102.45
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Nomi Health Commercial |
$93.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.37
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.74
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$79.79
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
IP
|
$606.79
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.09 |
| Max. Negotiated Rate |
$606.79 |
| Rate for Payer: Aetna Commercial |
$546.11
|
| Rate for Payer: ASR ASR |
$588.59
|
| Rate for Payer: BCBS Trust/PPO |
$498.30
|
| Rate for Payer: BCN Commercial |
$498.30
|
| Rate for Payer: Cash Price |
$485.43
|
| Rate for Payer: Cofinity Commercial |
$570.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.43
|
| Rate for Payer: Healthscope Commercial |
$588.59
|
| Rate for Payer: Healthscope Whirlpool |
$606.79
|
| Rate for Payer: Mclaren Commercial |
$546.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515.77
|
| Rate for Payer: Nomi Health Commercial |
$497.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.98
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
OP
|
$606.79
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.51 |
| Max. Negotiated Rate |
$606.79 |
| Rate for Payer: Aetna Commercial |
$546.11
|
| Rate for Payer: Aetna Medicare |
$224.51
|
| Rate for Payer: ASR ASR |
$588.59
|
| Rate for Payer: BCBS Complete |
$242.72
|
| Rate for Payer: BCBS Trust/PPO |
$500.30
|
| Rate for Payer: BCN Commercial |
$500.30
|
| Rate for Payer: Cash Price |
$485.43
|
| Rate for Payer: Cofinity Commercial |
$570.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$485.43
|
| Rate for Payer: Healthscope Commercial |
$588.59
|
| Rate for Payer: Healthscope Whirlpool |
$606.79
|
| Rate for Payer: Mclaren Commercial |
$546.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$485.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515.77
|
| Rate for Payer: Nomi Health Commercial |
$497.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$531.67
|
| Rate for Payer: Priority Health Narrow Network |
$425.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.98
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$1,031.84
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$1,210.70 |
| Rate for Payer: Aetna Commercial |
$928.66
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,000.88
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$850.75
|
| Rate for Payer: BCN Commercial |
$850.75
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$825.47
|
| Rate for Payer: Cash Price |
$825.47
|
| Rate for Payer: Cofinity Commercial |
$969.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,000.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$928.66
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.06
|
| Rate for Payer: Nomi Health Commercial |
$846.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.88
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,208.14
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$966.51
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$1,031.84
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$773.88 |
| Max. Negotiated Rate |
$1,031.84 |
| Rate for Payer: Aetna Commercial |
$928.66
|
| Rate for Payer: ASR ASR |
$1,000.88
|
| Rate for Payer: BCBS Trust/PPO |
$847.35
|
| Rate for Payer: BCN Commercial |
$847.35
|
| Rate for Payer: Cash Price |
$825.47
|
| Rate for Payer: Cofinity Commercial |
$969.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.47
|
| Rate for Payer: Healthscope Commercial |
$1,000.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.84
|
| Rate for Payer: Mclaren Commercial |
$928.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.06
|
| Rate for Payer: Nomi Health Commercial |
$846.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.02
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
OP
|
$138.70
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: Aetna Commercial |
$124.83
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$134.54
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$114.36
|
| Rate for Payer: BCN Commercial |
$114.36
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$110.96
|
| Rate for Payer: Cash Price |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$130.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Healthscope Whirlpool |
$138.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$124.83
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| 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 |
$47.62
|
| 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 |
$117.89
|
| Rate for Payer: Nomi Health Commercial |
$113.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.03
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| 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/Tiered Network |
$183.40
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$146.72
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$138.70
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.03 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$124.83
|
| Rate for Payer: ASR ASR |
$134.54
|
| Rate for Payer: BCBS Trust/PPO |
$113.90
|
| Rate for Payer: BCN Commercial |
$113.90
|
| Rate for Payer: Cash Price |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$130.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.96
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Healthscope Whirlpool |
$138.70
|
| Rate for Payer: Mclaren Commercial |
$124.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.89
|
| Rate for Payer: Nomi Health Commercial |
$113.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.06
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,249.22
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$936.91 |
| Max. Negotiated Rate |
$1,249.22 |
| Rate for Payer: Aetna Commercial |
$1,124.30
|
| Rate for Payer: ASR ASR |
$1,211.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.86
|
| Rate for Payer: BCN Commercial |
$1,025.86
|
| Rate for Payer: Cash Price |
$999.38
|
| Rate for Payer: Cofinity Commercial |
$1,174.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$999.38
|
| Rate for Payer: Healthscope Commercial |
$1,211.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.22
|
| Rate for Payer: Mclaren Commercial |
$1,124.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.84
|
| Rate for Payer: Nomi Health Commercial |
$1,024.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,099.31
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,249.22
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,249.22 |
| Rate for Payer: Aetna Commercial |
$1,124.30
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,211.74
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.98
|
| Rate for Payer: BCN Commercial |
$1,029.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$999.38
|
| Rate for Payer: Cash Price |
$999.38
|
| Rate for Payer: Cofinity Commercial |
$1,174.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$999.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,211.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,124.30
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$1,061.84
|
| Rate for Payer: Nomi Health Commercial |
$1,024.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.91
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$1,094.57
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$875.70
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,099.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$277.66
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$277.66 |
| Rate for Payer: Aetna Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$269.33
|
| Rate for Payer: BCBS Trust/PPO |
$228.01
|
| Rate for Payer: BCN Commercial |
$228.01
|
| Rate for Payer: Cash Price |
$222.13
|
| Rate for Payer: Cofinity Commercial |
$261.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.13
|
| Rate for Payer: Healthscope Commercial |
$269.33
|
| Rate for Payer: Healthscope Whirlpool |
$277.66
|
| Rate for Payer: Mclaren Commercial |
$249.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.01
|
| Rate for Payer: Nomi Health Commercial |
$227.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.34
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$277.66
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$277.66 |
| Rate for Payer: Aetna Commercial |
$249.89
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$269.33
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$228.93
|
| Rate for Payer: BCN Commercial |
$228.93
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$222.13
|
| Rate for Payer: Cash Price |
$222.13
|
| Rate for Payer: Cofinity Commercial |
$261.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$269.33
|
| Rate for Payer: Healthscope Whirlpool |
$277.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$249.89
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| 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 |
$47.62
|
| 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 |
$236.01
|
| Rate for Payer: Nomi Health Commercial |
$227.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.25
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| 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/Tiered Network |
$243.29
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$194.64
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$318.47
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$343.24
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$291.76
|
| Rate for Payer: BCN Commercial |
$291.76
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$332.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$343.24
|
| Rate for Payer: Healthscope Whirlpool |
$353.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$318.47
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: Nomi Health Commercial |
$290.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.39
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$194.91
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$155.93
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$353.86
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.39 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$318.47
|
| Rate for Payer: ASR ASR |
$343.24
|
| Rate for Payer: BCBS Trust/PPO |
$290.59
|
| Rate for Payer: BCN Commercial |
$290.59
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$332.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$343.24
|
| Rate for Payer: Healthscope Whirlpool |
$353.86
|
| Rate for Payer: Mclaren Commercial |
$318.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: Nomi Health Commercial |
$290.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.40
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Trust/PPO |
$285.08
|
| Rate for Payer: BCN Commercial |
$285.08
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$286.23
|
| Rate for Payer: BCN Commercial |
$286.23
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| 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 |
$47.62
|
| 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 |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| 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/Tiered Network |
$266.32
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$213.06
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$312.56 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$303.18
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$257.71
|
| Rate for Payer: BCN Commercial |
$257.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$293.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$303.18
|
| Rate for Payer: Healthscope Whirlpool |
$312.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| 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 |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| 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/Tiered Network |
$266.32
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$213.06
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$312.56 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.18
|
| Rate for Payer: BCBS Trust/PPO |
$256.67
|
| Rate for Payer: BCN Commercial |
$256.67
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$293.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$303.18
|
| Rate for Payer: Healthscope Whirlpool |
$312.56
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.05
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$302.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.70 |
| Max. Negotiated Rate |
$302.27 |
| Rate for Payer: Aetna Commercial |
$272.04
|
| Rate for Payer: ASR ASR |
$293.20
|
| Rate for Payer: BCBS Trust/PPO |
$248.22
|
| Rate for Payer: BCN Commercial |
$248.22
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$284.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.82
|
| Rate for Payer: Healthscope Commercial |
$293.20
|
| Rate for Payer: Healthscope Whirlpool |
$302.27
|
| Rate for Payer: Mclaren Commercial |
$272.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.93
|
| Rate for Payer: Nomi Health Commercial |
$247.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.00
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$302.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$302.27 |
| Rate for Payer: Aetna Commercial |
$272.04
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$293.20
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$249.22
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$284.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$293.20
|
| Rate for Payer: Healthscope Whirlpool |
$302.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$272.04
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.93
|
| Rate for Payer: Nomi Health Commercial |
$247.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.70
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$132.56
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$106.05
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.27 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$343.29
|
| Rate for Payer: BCN Commercial |
$343.29
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$610.12
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$488.10
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
