|
HC XR TIB FIB 2 VIEWS
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.23
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC XR TIB FIB BIL 2 VW
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC XR TIB FIB BIL 2 VW
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| 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 |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| 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 |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.59
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$272.49
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
| 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 TMJ COMPLETE BIL
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ COMPLETE BIL
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ LTD
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
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 TMJ LTD
|
Facility
|
OP
|
$111.60
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Aetna Commercial |
$100.44
|
| 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 |
$108.25
|
| Rate for Payer: ASR Commercial |
$108.25
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$91.39
|
| Rate for Payer: BCN Commercial |
$86.52
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| 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 |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Healthscope Whirlpool |
$108.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$100.44
|
| 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 |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| 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 |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.78
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$78.23
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.21
|
| 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 TOES BIL MIN 2 VIEWS
|
Facility
|
IP
|
$223.85
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| Rate for Payer: ASR ASR |
$217.13
|
| Rate for Payer: ASR Commercial |
$217.13
|
| Rate for Payer: BCBS Trust/PPO |
$182.42
|
| Rate for Payer: BCN Commercial |
$173.55
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cofinity Commercial |
$210.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Healthscope Commercial |
$223.85
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Mclaren Commercial |
$201.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.99
|
|
|
HC XR TOES BIL MIN 2 VIEWS
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$223.85 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| 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 |
$217.13
|
| Rate for Payer: ASR Commercial |
$217.13
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$183.31
|
| Rate for Payer: BCN Commercial |
$173.55
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cofinity Commercial |
$210.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$223.85
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$201.47
|
| 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 |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| 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 |
$145.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.14
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$156.92
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.99
|
| 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 TOES MIN 2 VIEWS
|
Facility
|
OP
|
$194.04
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Aetna Commercial |
$174.64
|
| 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 |
$188.22
|
| Rate for Payer: ASR Commercial |
$188.22
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$158.90
|
| Rate for Payer: BCN Commercial |
$150.44
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cofinity Commercial |
$182.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$194.04
|
| Rate for Payer: Healthscope Whirlpool |
$188.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$174.64
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.93
|
| Rate for Payer: Nomi Health Commercial |
$159.11
|
| 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 |
$126.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.02
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$136.02
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.76
|
| 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 TOES MIN 2 VIEWS
|
Facility
|
IP
|
$194.04
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Aetna Commercial |
$174.64
|
| Rate for Payer: ASR ASR |
$188.22
|
| Rate for Payer: ASR Commercial |
$188.22
|
| Rate for Payer: BCBS Trust/PPO |
$158.12
|
| Rate for Payer: BCN Commercial |
$150.44
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cofinity Commercial |
$182.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.23
|
| Rate for Payer: Healthscope Commercial |
$194.04
|
| Rate for Payer: Healthscope Whirlpool |
$188.22
|
| Rate for Payer: Mclaren Commercial |
$174.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.93
|
| Rate for Payer: Nomi Health Commercial |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.76
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
IP
|
$296.20
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.53 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$266.58
|
| Rate for Payer: ASR ASR |
$287.31
|
| Rate for Payer: ASR Commercial |
$287.31
|
| Rate for Payer: BCBS Trust/PPO |
$241.37
|
| Rate for Payer: BCN Commercial |
$229.64
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cofinity Commercial |
$278.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.96
|
| Rate for Payer: Healthscope Commercial |
$296.20
|
| Rate for Payer: Healthscope Whirlpool |
$287.31
|
| Rate for Payer: Mclaren Commercial |
$266.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.77
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.66
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
OP
|
$296.20
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$296.20 |
| Rate for Payer: Aetna Commercial |
$266.58
|
| 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 |
$287.31
|
| Rate for Payer: ASR Commercial |
$287.31
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$242.56
|
| Rate for Payer: BCN Commercial |
$229.64
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cofinity Commercial |
$278.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$296.20
|
| Rate for Payer: Healthscope Whirlpool |
$287.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$266.58
|
| 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 |
$251.77
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| 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 |
$192.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.53
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$207.64
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.66
|
| 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 UPPER GI
|
Facility
|
IP
|
$583.54
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$379.30 |
| Max. Negotiated Rate |
$583.54 |
| Rate for Payer: Aetna Commercial |
$525.19
|
| Rate for Payer: ASR ASR |
$566.03
|
| Rate for Payer: ASR Commercial |
$566.03
|
| Rate for Payer: BCBS Trust/PPO |
$475.53
|
| Rate for Payer: BCN Commercial |
$452.42
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$548.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.83
|
| Rate for Payer: Healthscope Commercial |
$583.54
|
| Rate for Payer: Healthscope Whirlpool |
$566.03
|
| Rate for Payer: Mclaren Commercial |
$525.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.01
|
| Rate for Payer: Nomi Health Commercial |
$478.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.52
|
|
|
HC XR UPPER GI
|
Facility
|
OP
|
$583.54
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$583.54 |
| Rate for Payer: Aetna Commercial |
$525.19
|
| 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 |
$566.03
|
| Rate for Payer: ASR Commercial |
$566.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$477.86
|
| Rate for Payer: BCN Commercial |
$452.42
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$548.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$583.54
|
| Rate for Payer: Healthscope Whirlpool |
$566.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$525.19
|
| 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 |
$496.01
|
| Rate for Payer: Nomi Health Commercial |
$478.50
|
| 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 |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.30
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$409.06
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.52
|
| 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 URETHROGRAM RETROGRADE
|
Facility
|
IP
|
$509.20
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.98 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Aetna Commercial |
$458.28
|
| Rate for Payer: ASR ASR |
$493.92
|
| Rate for Payer: ASR Commercial |
$493.92
|
| Rate for Payer: BCBS Trust/PPO |
$414.95
|
| Rate for Payer: BCN Commercial |
$394.78
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cofinity Commercial |
$478.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.36
|
| Rate for Payer: Healthscope Commercial |
$509.20
|
| Rate for Payer: Healthscope Whirlpool |
$493.92
|
| Rate for Payer: Mclaren Commercial |
$458.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.82
|
| Rate for Payer: Nomi Health Commercial |
$417.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.10
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
OP
|
$509.20
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Aetna Commercial |
$458.28
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$493.92
|
| Rate for Payer: ASR Commercial |
$493.92
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$416.98
|
| Rate for Payer: BCN Commercial |
$394.78
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cofinity Commercial |
$478.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$509.20
|
| Rate for Payer: Healthscope Whirlpool |
$493.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$458.28
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.82
|
| Rate for Payer: Nomi Health Commercial |
$417.54
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.16
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$356.95
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
OP
|
$792.88
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$792.88 |
| Rate for Payer: Aetna Commercial |
$713.59
|
| 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 |
$769.09
|
| Rate for Payer: ASR Commercial |
$769.09
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$649.29
|
| Rate for Payer: BCN Commercial |
$614.72
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cofinity Commercial |
$745.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$792.88
|
| Rate for Payer: Healthscope Whirlpool |
$769.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$713.59
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.95
|
| Rate for Payer: Nomi Health Commercial |
$650.16
|
| 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 |
$515.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$694.72
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$555.81
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.73
|
| 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 UROGRAPHY INF
|
Facility
|
IP
|
$792.88
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$515.37 |
| Max. Negotiated Rate |
$792.88 |
| Rate for Payer: Aetna Commercial |
$713.59
|
| Rate for Payer: ASR ASR |
$769.09
|
| Rate for Payer: ASR Commercial |
$769.09
|
| Rate for Payer: BCBS Trust/PPO |
$646.12
|
| Rate for Payer: BCN Commercial |
$614.72
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cofinity Commercial |
$745.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.30
|
| Rate for Payer: Healthscope Commercial |
$792.88
|
| Rate for Payer: Healthscope Whirlpool |
$769.09
|
| Rate for Payer: Mclaren Commercial |
$713.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.95
|
| Rate for Payer: Nomi Health Commercial |
$650.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.73
|
|
|
HC XR WRIST 2 VW
|
Facility
|
OP
|
$255.46
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$255.46 |
| Rate for Payer: Aetna Commercial |
$229.91
|
| 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 |
$247.80
|
| Rate for Payer: ASR Commercial |
$247.80
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$209.20
|
| Rate for Payer: BCN Commercial |
$198.06
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$240.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$255.46
|
| Rate for Payer: Healthscope Whirlpool |
$247.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$229.91
|
| 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 |
$217.14
|
| Rate for Payer: Nomi Health Commercial |
$209.48
|
| 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 |
$166.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.83
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$179.08
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.80
|
| 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 WRIST 2 VW
|
Facility
|
IP
|
$255.46
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$255.46 |
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: ASR ASR |
$247.80
|
| Rate for Payer: ASR Commercial |
$247.80
|
| Rate for Payer: BCBS Trust/PPO |
$208.17
|
| Rate for Payer: BCN Commercial |
$198.06
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$240.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$255.46
|
| Rate for Payer: Healthscope Whirlpool |
$247.80
|
| Rate for Payer: Mclaren Commercial |
$229.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: Nomi Health Commercial |
$209.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.80
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| Rate for Payer: ASR ASR |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Trust/PPO |
$237.82
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| 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 |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$238.99
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| 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 |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| 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 |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.71
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$204.58
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
| 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 WRIST BIL MIN 3 VW
|
Facility
|
IP
|
$451.65
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.57 |
| Max. Negotiated Rate |
$451.65 |
| Rate for Payer: Aetna Commercial |
$406.49
|
| Rate for Payer: ASR ASR |
$438.10
|
| Rate for Payer: ASR Commercial |
$438.10
|
| Rate for Payer: BCBS Trust/PPO |
$368.05
|
| Rate for Payer: BCN Commercial |
$350.16
|
| Rate for Payer: Cash Price |
$361.32
|
| Rate for Payer: Cofinity Commercial |
$424.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.32
|
| Rate for Payer: Healthscope Commercial |
$451.65
|
| Rate for Payer: Healthscope Whirlpool |
$438.10
|
| Rate for Payer: Mclaren Commercial |
$406.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.90
|
| Rate for Payer: Nomi Health Commercial |
$370.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.45
|
|
|
HC XR WRIST BIL MIN 3 VW
|
Facility
|
OP
|
$451.65
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$451.65 |
| Rate for Payer: Aetna Commercial |
$406.49
|
| 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 |
$438.10
|
| Rate for Payer: ASR Commercial |
$438.10
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$369.86
|
| Rate for Payer: BCN Commercial |
$350.16
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$361.32
|
| Rate for Payer: Cash Price |
$361.32
|
| Rate for Payer: Cofinity Commercial |
$424.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$451.65
|
| Rate for Payer: Healthscope Whirlpool |
$438.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$406.49
|
| 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 |
$383.90
|
| Rate for Payer: Nomi Health Commercial |
$370.35
|
| 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 |
$293.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.74
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$316.61
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.45
|
| 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
|
|
