|
HC XR SPINE THORACOLUMBAR 2 VW
|
Facility
|
OP
|
$390.58
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$390.58 |
| Rate for Payer: Aetna Commercial |
$351.52
|
| 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 |
$378.86
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$322.03
|
| Rate for Payer: BCN Commercial |
$322.03
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cofinity Commercial |
$367.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$378.86
|
| Rate for Payer: Healthscope Whirlpool |
$390.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$351.52
|
| 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 |
$331.99
|
| Rate for Payer: Nomi Health Commercial |
$320.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.94
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$342.23
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$273.80
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.71
|
| 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 SPINE THORACOLUMBAR 2 VW
|
Facility
|
IP
|
$390.58
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.94 |
| Max. Negotiated Rate |
$390.58 |
| Rate for Payer: Aetna Commercial |
$351.52
|
| Rate for Payer: ASR ASR |
$378.86
|
| Rate for Payer: BCBS Trust/PPO |
$320.74
|
| Rate for Payer: BCN Commercial |
$320.74
|
| Rate for Payer: Cash Price |
$312.46
|
| Rate for Payer: Cofinity Commercial |
$367.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.46
|
| Rate for Payer: Healthscope Commercial |
$378.86
|
| Rate for Payer: Healthscope Whirlpool |
$390.58
|
| Rate for Payer: Mclaren Commercial |
$351.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.99
|
| Rate for Payer: Nomi Health Commercial |
$320.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.71
|
|
|
HC XR STERNOCLAV JTS MIN 3 VW
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 STERNOCLAV JTS MIN 3 VW
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$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 |
$144.66
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$115.73
|
| 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 STERNUM MIN 2 VW
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC XR STERNUM MIN 2 VW
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| 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 |
$353.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| 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 |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$144.66
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$115.73
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| 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 SWALLOWING FUNC W CINE VIDE
|
Facility
|
OP
|
$593.63
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$611.94 |
| Rate for Payer: Aetna Commercial |
$534.27
|
| 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 |
$575.82
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$489.45
|
| Rate for Payer: BCN Commercial |
$489.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Commercial |
$558.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$575.82
|
| Rate for Payer: Healthscope Whirlpool |
$593.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$534.27
|
| 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 |
$504.59
|
| Rate for Payer: Nomi Health Commercial |
$486.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$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 |
$611.94
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$489.55
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.39
|
| 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 SWALLOWING FUNC W CINE VIDE
|
Facility
|
IP
|
$593.63
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.22 |
| Max. Negotiated Rate |
$593.63 |
| Rate for Payer: Aetna Commercial |
$534.27
|
| Rate for Payer: ASR ASR |
$575.82
|
| Rate for Payer: BCBS Trust/PPO |
$487.49
|
| Rate for Payer: BCN Commercial |
$487.49
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cofinity Commercial |
$558.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$474.90
|
| Rate for Payer: Healthscope Commercial |
$575.82
|
| Rate for Payer: Healthscope Whirlpool |
$593.63
|
| Rate for Payer: Mclaren Commercial |
$534.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.59
|
| Rate for Payer: Nomi Health Commercial |
$486.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.39
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
IP
|
$228.33
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$228.33 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: ASR ASR |
$221.48
|
| Rate for Payer: BCBS Trust/PPO |
$187.50
|
| Rate for Payer: BCN Commercial |
$187.50
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Healthscope Commercial |
$221.48
|
| Rate for Payer: Healthscope Whirlpool |
$228.33
|
| Rate for Payer: Mclaren Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$187.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.93
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
OP
|
$228.33
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$221.48
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$188.26
|
| Rate for Payer: BCN Commercial |
$188.26
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$221.48
|
| Rate for Payer: Healthscope Whirlpool |
$228.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$205.50
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$187.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.06
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$160.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
OP
|
$172.67
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$155.40
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$167.49
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$142.37
|
| Rate for Payer: BCN Commercial |
$142.37
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$138.14
|
| Rate for Payer: Cash Price |
$138.14
|
| Rate for Payer: Cofinity Commercial |
$162.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$167.49
|
| Rate for Payer: Healthscope Whirlpool |
$172.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$155.40
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.77
|
| Rate for Payer: Nomi Health Commercial |
$141.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.50
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.29
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$121.04
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
IP
|
$172.67
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$172.67 |
| Rate for Payer: Aetna Commercial |
$155.40
|
| Rate for Payer: ASR ASR |
$167.49
|
| Rate for Payer: BCBS Trust/PPO |
$141.80
|
| Rate for Payer: BCN Commercial |
$141.80
|
| Rate for Payer: Cash Price |
$138.14
|
| Rate for Payer: Cofinity Commercial |
$162.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.14
|
| Rate for Payer: Healthscope Commercial |
$167.49
|
| Rate for Payer: Healthscope Whirlpool |
$172.67
|
| Rate for Payer: Mclaren Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.77
|
| Rate for Payer: Nomi Health Commercial |
$141.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.95
|
|
|
HC XR TIB FIB 2 VIEWS
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC XR TIB FIB 2 VIEWS
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| 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 |
$353.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| 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 |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$285.68
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$228.55
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| 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 TIB FIB BIL 2 VW
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC XR TIB FIB BIL 2 VW
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| 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 |
$384.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| 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 |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$285.68
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$228.55
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
| 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 TMJ COMPLETE BIL
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| 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 |
$403.87
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$343.29
|
| Rate for Payer: BCN Commercial |
$343.29
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| 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 |
$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 |
$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 |
$171.29
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$137.03
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
| 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 TMJ COMPLETE BIL
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ LTD
|
Facility
|
OP
|
$113.83
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$102.45
|
| 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 |
$110.42
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$93.85
|
| Rate for Payer: BCN Commercial |
$93.85
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Cofinity Commercial |
$107.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Healthscope Whirlpool |
$113.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$102.45
|
| 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 |
$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 |
$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 |
$99.74
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$79.79
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.17
|
| 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 TMJ LTD
|
Facility
|
IP
|
$113.83
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
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 TOES BIL MIN 2 VIEWS
|
Facility
|
OP
|
$228.33
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$228.33 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| 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 |
$221.48
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$188.26
|
| Rate for Payer: BCN Commercial |
$188.26
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$221.48
|
| Rate for Payer: Healthscope Whirlpool |
$228.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$205.50
|
| 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 |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$187.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$122.25
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$97.80
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.93
|
| 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 TOES BIL MIN 2 VIEWS
|
Facility
|
IP
|
$228.33
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$228.33 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: ASR ASR |
$221.48
|
| Rate for Payer: BCBS Trust/PPO |
$187.50
|
| Rate for Payer: BCN Commercial |
$187.50
|
| Rate for Payer: Cash Price |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$214.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.66
|
| Rate for Payer: Healthscope Commercial |
$221.48
|
| Rate for Payer: Healthscope Whirlpool |
$228.33
|
| Rate for Payer: Mclaren Commercial |
$205.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.08
|
| Rate for Payer: Nomi Health Commercial |
$187.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.93
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
IP
|
$197.92
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$197.92 |
| Rate for Payer: Aetna Commercial |
$178.13
|
| Rate for Payer: ASR ASR |
$191.98
|
| Rate for Payer: BCBS Trust/PPO |
$162.53
|
| Rate for Payer: BCN Commercial |
$162.53
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cofinity Commercial |
$186.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.34
|
| Rate for Payer: Healthscope Commercial |
$191.98
|
| Rate for Payer: Healthscope Whirlpool |
$197.92
|
| Rate for Payer: Mclaren Commercial |
$178.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.23
|
| Rate for Payer: Nomi Health Commercial |
$162.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.17
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
OP
|
$197.92
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$197.92 |
| Rate for Payer: Aetna Commercial |
$178.13
|
| 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 |
$191.98
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$163.19
|
| Rate for Payer: BCN Commercial |
$163.19
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cash Price |
$158.34
|
| Rate for Payer: Cofinity Commercial |
$186.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$191.98
|
| Rate for Payer: Healthscope Whirlpool |
$197.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$178.13
|
| 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 |
$168.23
|
| Rate for Payer: Nomi Health Commercial |
$162.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.44
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$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 |
$122.25
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$97.80
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.17
|
| 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 UGI GASTRO THIN BARM
|
Facility
|
OP
|
$315.25
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| 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 |
$305.79
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$259.92
|
| Rate for Payer: BCN Commercial |
$259.92
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cofinity Commercial |
$296.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$305.79
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$283.73
|
| 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 |
$267.96
|
| Rate for Payer: Nomi Health Commercial |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.44
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$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 |
$276.22
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$220.99
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.42
|
| 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
|
|
