|
HC XR KNEE 4 VIEWS
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.66
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$286.15
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR KNEE 4 VIEWS
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.22 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Trust/PPO |
$277.34
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$278.70
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.21
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$238.58
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.66
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$286.15
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
IP
|
$244.99
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$244.99 |
| Rate for Payer: Aetna Commercial |
$220.49
|
| Rate for Payer: ASR ASR |
$237.64
|
| Rate for Payer: ASR Commercial |
$237.64
|
| Rate for Payer: BCBS Trust/PPO |
$199.64
|
| Rate for Payer: BCN Commercial |
$189.94
|
| Rate for Payer: Cash Price |
$195.99
|
| Rate for Payer: Cofinity Commercial |
$230.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.99
|
| Rate for Payer: Healthscope Commercial |
$244.99
|
| Rate for Payer: Healthscope Whirlpool |
$237.64
|
| Rate for Payer: Mclaren Commercial |
$220.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.24
|
| Rate for Payer: Nomi Health Commercial |
$200.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.59
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
OP
|
$244.99
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$244.99 |
| Rate for Payer: Aetna Commercial |
$220.49
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$237.64
|
| Rate for Payer: ASR Commercial |
$237.64
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$200.62
|
| Rate for Payer: BCN Commercial |
$189.94
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$195.99
|
| Rate for Payer: Cash Price |
$195.99
|
| Rate for Payer: Cofinity Commercial |
$230.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$244.99
|
| Rate for Payer: Healthscope Whirlpool |
$237.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$220.49
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.24
|
| Rate for Payer: Nomi Health Commercial |
$200.89
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.66
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$171.74
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Aetna Commercial |
$413.60
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$445.76
|
| Rate for Payer: ASR Commercial |
$445.76
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$376.33
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$431.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$459.55
|
| Rate for Payer: Healthscope Whirlpool |
$445.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$413.60
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.66
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$322.14
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$404.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
IP
|
$459.55
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.71 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Aetna Commercial |
$413.60
|
| Rate for Payer: ASR ASR |
$445.76
|
| Rate for Payer: ASR Commercial |
$445.76
|
| Rate for Payer: BCBS Trust/PPO |
$374.49
|
| Rate for Payer: BCN Commercial |
$356.29
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$431.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$459.55
|
| Rate for Payer: Healthscope Whirlpool |
$445.76
|
| Rate for Payer: Mclaren Commercial |
$413.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$404.40
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
OP
|
$117.98
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$160.75 |
| Rate for Payer: Aetna Commercial |
$106.18
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$114.44
|
| Rate for Payer: ASR Commercial |
$114.44
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$96.61
|
| Rate for Payer: BCN Commercial |
$91.47
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$94.38
|
| Rate for Payer: Cash Price |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$110.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$106.18
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.28
|
| Rate for Payer: Nomi Health Commercial |
$96.74
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.37
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$82.70
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
IP
|
$117.98
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$117.98 |
| Rate for Payer: Aetna Commercial |
$106.18
|
| Rate for Payer: ASR ASR |
$114.44
|
| Rate for Payer: ASR Commercial |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$96.14
|
| Rate for Payer: BCN Commercial |
$91.47
|
| Rate for Payer: Cash Price |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$110.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.38
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| Rate for Payer: Healthscope Whirlpool |
$114.44
|
| Rate for Payer: Mclaren Commercial |
$106.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.28
|
| Rate for Payer: Nomi Health Commercial |
$96.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.82
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$100.44
|
| Rate for Payer: ASR ASR |
$108.25
|
| Rate for Payer: ASR Commercial |
$108.25
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$86.52
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$104.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Healthscope Whirlpool |
$108.25
|
| Rate for Payer: Mclaren Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.21
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
OP
|
$111.60
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$160.75 |
| Rate for Payer: Aetna Commercial |
$100.44
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$108.25
|
| Rate for Payer: ASR Commercial |
$108.25
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$91.39
|
| Rate for Payer: BCN Commercial |
$86.52
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$104.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Healthscope Whirlpool |
$108.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$100.44
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.78
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$78.23
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
OP
|
$594.89
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.96 |
| Max. Negotiated Rate |
$594.89 |
| Rate for Payer: Aetna Commercial |
$535.40
|
| Rate for Payer: Aetna Medicare |
$297.44
|
| Rate for Payer: ASR ASR |
$577.04
|
| Rate for Payer: ASR Commercial |
$577.04
|
| Rate for Payer: BCBS Complete |
$237.96
|
| Rate for Payer: BCBS Trust/PPO |
$487.16
|
| Rate for Payer: BCN Commercial |
$461.22
|
| Rate for Payer: Cash Price |
$475.91
|
| Rate for Payer: Cofinity Commercial |
$559.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.91
|
| Rate for Payer: Healthscope Commercial |
$594.89
|
| Rate for Payer: Healthscope Whirlpool |
$577.04
|
| Rate for Payer: Mclaren Commercial |
$535.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.66
|
| Rate for Payer: Nomi Health Commercial |
$487.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.24
|
| Rate for Payer: Priority Health Narrow Network |
$417.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.50
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
IP
|
$594.89
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$594.89 |
| Rate for Payer: Aetna Commercial |
$535.40
|
| Rate for Payer: ASR ASR |
$577.04
|
| Rate for Payer: ASR Commercial |
$577.04
|
| Rate for Payer: BCBS Trust/PPO |
$484.78
|
| Rate for Payer: BCN Commercial |
$461.22
|
| Rate for Payer: Cash Price |
$475.91
|
| Rate for Payer: Cofinity Commercial |
$559.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.91
|
| Rate for Payer: Healthscope Commercial |
$594.89
|
| Rate for Payer: Healthscope Whirlpool |
$577.04
|
| Rate for Payer: Mclaren Commercial |
$535.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.66
|
| Rate for Payer: Nomi Health Commercial |
$487.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.50
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$1,011.61
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,194.32 |
| Rate for Payer: Aetna Commercial |
$910.45
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$981.26
|
| Rate for Payer: ASR Commercial |
$981.26
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$828.41
|
| Rate for Payer: BCN Commercial |
$784.30
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$809.29
|
| Rate for Payer: Cash Price |
$809.29
|
| Rate for Payer: Cofinity Commercial |
$950.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,011.61
|
| Rate for Payer: Healthscope Whirlpool |
$981.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$910.45
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.87
|
| Rate for Payer: Nomi Health Commercial |
$829.52
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$886.37
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$709.14
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$890.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$1,011.61
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$657.55 |
| Max. Negotiated Rate |
$1,011.61 |
| Rate for Payer: Aetna Commercial |
$910.45
|
| Rate for Payer: ASR ASR |
$981.26
|
| Rate for Payer: ASR Commercial |
$981.26
|
| Rate for Payer: BCBS Trust/PPO |
$824.36
|
| Rate for Payer: BCN Commercial |
$784.30
|
| Rate for Payer: Cash Price |
$809.29
|
| Rate for Payer: Cofinity Commercial |
$950.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.29
|
| Rate for Payer: Healthscope Commercial |
$1,011.61
|
| Rate for Payer: Healthscope Whirlpool |
$981.26
|
| Rate for Payer: Mclaren Commercial |
$910.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.87
|
| Rate for Payer: Nomi Health Commercial |
$829.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$890.22
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$135.98
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.39 |
| Max. Negotiated Rate |
$135.98 |
| Rate for Payer: Aetna Commercial |
$122.38
|
| Rate for Payer: ASR ASR |
$131.90
|
| Rate for Payer: ASR Commercial |
$131.90
|
| Rate for Payer: BCBS Trust/PPO |
$110.81
|
| Rate for Payer: BCN Commercial |
$105.43
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$127.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Healthscope Commercial |
$135.98
|
| Rate for Payer: Healthscope Whirlpool |
$131.90
|
| Rate for Payer: Mclaren Commercial |
$122.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.58
|
| Rate for Payer: Nomi Health Commercial |
$111.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.66
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
OP
|
$135.98
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$135.98 |
| Rate for Payer: Aetna Commercial |
$122.38
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$131.90
|
| Rate for Payer: ASR Commercial |
$131.90
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$111.35
|
| Rate for Payer: BCN Commercial |
$105.43
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$127.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$135.98
|
| Rate for Payer: Healthscope Whirlpool |
$131.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$122.38
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.58
|
| Rate for Payer: Nomi Health Commercial |
$111.50
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.15
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$95.32
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,224.73
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$796.07 |
| Max. Negotiated Rate |
$1,224.73 |
| Rate for Payer: Aetna Commercial |
$1,102.26
|
| Rate for Payer: ASR ASR |
$1,187.99
|
| Rate for Payer: ASR Commercial |
$1,187.99
|
| Rate for Payer: BCBS Trust/PPO |
$998.03
|
| Rate for Payer: BCN Commercial |
$949.53
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cofinity Commercial |
$1,151.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.78
|
| Rate for Payer: Healthscope Commercial |
$1,224.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,187.99
|
| Rate for Payer: Mclaren Commercial |
$1,102.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.02
|
| Rate for Payer: Nomi Health Commercial |
$1,004.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,077.76
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,224.73
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,224.73 |
| Rate for Payer: Aetna Commercial |
$1,102.26
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,187.99
|
| Rate for Payer: ASR Commercial |
$1,187.99
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.93
|
| Rate for Payer: BCN Commercial |
$949.53
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cofinity Commercial |
$1,151.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,224.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,187.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,102.26
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.02
|
| Rate for Payer: Nomi Health Commercial |
$1,004.28
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,073.11
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$858.54
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,077.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$272.22
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.94 |
| Max. Negotiated Rate |
$272.22 |
| Rate for Payer: Aetna Commercial |
$245.00
|
| Rate for Payer: ASR ASR |
$264.05
|
| Rate for Payer: ASR Commercial |
$264.05
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$211.05
|
| Rate for Payer: Cash Price |
$217.78
|
| Rate for Payer: Cofinity Commercial |
$255.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.78
|
| Rate for Payer: Healthscope Commercial |
$272.22
|
| Rate for Payer: Healthscope Whirlpool |
$264.05
|
| Rate for Payer: Mclaren Commercial |
$245.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.39
|
| Rate for Payer: Nomi Health Commercial |
$223.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.55
|
|
