|
HC XR KNEE 4 VIEWS
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.08 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: BCBS Trust/PPO |
$309.27
|
| Rate for Payer: BCN Commercial |
$309.27
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.18
|
| Rate for Payer: UHC Core |
$334.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
|
HC XR KNEE 4 VIEWS
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$104.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.06
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$100.05
|
| Rate for Payer: BCBS Trust/PPO |
$311.16
|
| Rate for Payer: BCN Commercial |
$311.16
|
| Rate for Payer: BCN Medicare Advantage |
$100.05
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.05
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Senior Care Partners |
$95.05
|
| Rate for Payer: PACE SWMI |
$100.05
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$100.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.17
|
| Rate for Payer: Priority Health Medicare |
$100.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.08
|
| Rate for Payer: Railroad Medicare Medicare |
$100.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.18
|
| Rate for Payer: UHC Core |
$334.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.05
|
| Rate for Payer: UHC Medicare Advantage |
$103.05
|
| Rate for Payer: VA VA |
$100.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.51 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: BCBS Trust/PPO |
$257.86
|
| Rate for Payer: BCN Commercial |
$257.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC XR KNEE BIL 1 OR 2 VW
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$86.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.27
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$259.43
|
| Rate for Payer: BCN Commercial |
$259.43
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Medicare |
$83.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$85.92
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.68 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: BCBS Trust/PPO |
$331.57
|
| Rate for Payer: BCN Commercial |
$331.57
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.56
|
| Rate for Payer: UHC Core |
$358.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.79
|
|
|
HC XR KNEE BIL 4 VW
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$111.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.08
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$107.26
|
| Rate for Payer: BCBS Trust/PPO |
$333.59
|
| Rate for Payer: BCN Commercial |
$333.59
|
| Rate for Payer: BCN Medicare Advantage |
$107.26
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.26
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.79
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Senior Care Partners |
$101.90
|
| Rate for Payer: PACE SWMI |
$107.26
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$107.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.27
|
| Rate for Payer: Priority Health Medicare |
$107.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.68
|
| Rate for Payer: Railroad Medicare Medicare |
$107.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.56
|
| Rate for Payer: UHC Core |
$358.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.26
|
| Rate for Payer: UHC Medicare Advantage |
$110.48
|
| Rate for Payer: VA VA |
$107.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.79
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.08 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: BCBS Trust/PPO |
$309.27
|
| Rate for Payer: BCN Commercial |
$309.27
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.18
|
| Rate for Payer: UHC Core |
$334.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
|
HC XR KNEES STANDING AP
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$104.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.06
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$100.05
|
| Rate for Payer: BCBS Trust/PPO |
$311.16
|
| Rate for Payer: BCN Commercial |
$311.16
|
| Rate for Payer: BCN Medicare Advantage |
$100.05
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.05
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Senior Care Partners |
$95.05
|
| Rate for Payer: PACE SWMI |
$100.05
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$100.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.17
|
| Rate for Payer: Priority Health Medicare |
$100.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.08
|
| Rate for Payer: Railroad Medicare Medicare |
$100.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.18
|
| Rate for Payer: UHC Core |
$334.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.05
|
| Rate for Payer: UHC Medicare Advantage |
$103.05
|
| Rate for Payer: VA VA |
$100.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
IP
|
$240.19
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.49 |
| Max. Negotiated Rate |
$216.17 |
| Rate for Payer: Aetna Commercial |
$204.16
|
| Rate for Payer: BCBS Trust/PPO |
$185.62
|
| Rate for Payer: BCN Commercial |
$185.62
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.15
|
| Rate for Payer: Healthscope Commercial |
$216.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.16
|
| Rate for Payer: PHP Commercial |
$204.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.37
|
| Rate for Payer: UHC Core |
$200.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.14
|
|
|
HC XR MANDIBLE LESS THAN 4 VW
|
Facility
|
OP
|
$240.19
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
32000005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$216.17 |
| Rate for Payer: Aetna Commercial |
$204.16
|
| Rate for Payer: Aetna Medicare |
$62.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.06
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$60.05
|
| Rate for Payer: BCBS Trust/PPO |
$186.75
|
| Rate for Payer: BCN Commercial |
$186.75
|
| Rate for Payer: BCN Medicare Advantage |
$60.05
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.05
|
| Rate for Payer: Healthscope Commercial |
$216.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.14
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.16
|
| Rate for Payer: PACE Senior Care Partners |
$57.05
|
| Rate for Payer: PACE SWMI |
$60.05
|
| Rate for Payer: PHP Commercial |
$204.16
|
| Rate for Payer: PHP Medicare Advantage |
$60.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.97
|
| Rate for Payer: Priority Health Medicare |
$60.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.49
|
| Rate for Payer: Railroad Medicare Medicare |
$60.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.37
|
| Rate for Payer: UHC Core |
$200.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.05
|
| Rate for Payer: UHC Medicare Advantage |
$61.85
|
| Rate for Payer: VA VA |
$60.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.14
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
OP
|
$450.54
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna Medicare |
$117.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.79
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$112.64
|
| Rate for Payer: BCBS Trust/PPO |
$350.29
|
| Rate for Payer: BCN Commercial |
$350.29
|
| Rate for Payer: BCN Medicare Advantage |
$112.64
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.64
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.90
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PACE Senior Care Partners |
$107.00
|
| Rate for Payer: PACE SWMI |
$112.64
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: PHP Medicare Advantage |
$112.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.97
|
| Rate for Payer: Priority Health Medicare |
$112.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.78
|
| Rate for Payer: Railroad Medicare Medicare |
$112.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.48
|
| Rate for Payer: UHC Core |
$376.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.64
|
| Rate for Payer: UHC Medicare Advantage |
$116.01
|
| Rate for Payer: VA VA |
$112.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.90
|
|
|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.78 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: BCBS Trust/PPO |
$348.18
|
| Rate for Payer: BCN Commercial |
$348.18
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.43
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.48
|
| Rate for Payer: UHC Core |
$376.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.90
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$30.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.15
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$28.92
|
| Rate for Payer: BCBS Trust/PPO |
$89.93
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: BCN Medicare Advantage |
$28.92
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PACE Senior Care Partners |
$27.47
|
| Rate for Payer: PACE SWMI |
$28.92
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: PHP Medicare Advantage |
$28.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.63
|
| Rate for Payer: Priority Health Medicare |
$28.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.79
|
| Rate for Payer: UHC Core |
$96.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.79
|
| Rate for Payer: VA VA |
$28.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: BCBS Trust/PPO |
$89.39
|
| Rate for Payer: BCN Commercial |
$89.39
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.79
|
| Rate for Payer: UHC Core |
$96.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
IP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: BCBS Trust/PPO |
$84.55
|
| Rate for Payer: BCN Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.28
|
| Rate for Payer: UHC Core |
$91.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
OP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare |
$28.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.19
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$27.35
|
| Rate for Payer: BCBS Trust/PPO |
$85.07
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: BCN Medicare Advantage |
$27.35
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PACE Senior Care Partners |
$25.98
|
| Rate for Payer: PACE SWMI |
$27.35
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.19
|
| Rate for Payer: Priority Health Medicare |
$27.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.73
|
| Rate for Payer: Railroad Medicare Medicare |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.28
|
| Rate for Payer: UHC Core |
$91.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.35
|
| Rate for Payer: UHC Medicare Advantage |
$28.17
|
| Rate for Payer: VA VA |
$27.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
OP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: Aetna Medicare |
$151.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.26
|
| Rate for Payer: BCBS Complete |
$233.29
|
| Rate for Payer: BCBS MAPPO |
$145.81
|
| Rate for Payer: BCBS Trust/PPO |
$453.46
|
| Rate for Payer: BCN Commercial |
$453.46
|
| Rate for Payer: BCN Medicare Advantage |
$145.81
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.81
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PACE Senior Care Partners |
$138.52
|
| Rate for Payer: PACE SWMI |
$145.81
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: PHP Medicare Advantage |
$145.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.41
|
| Rate for Payer: Priority Health Medicare |
$145.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.71
|
| Rate for Payer: Railroad Medicare Medicare |
$145.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.24
|
| Rate for Payer: UHC Core |
$487.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.81
|
| Rate for Payer: UHC Medicare Advantage |
$150.18
|
| Rate for Payer: VA VA |
$145.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.42
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
IP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.71 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: BCBS Trust/PPO |
$450.72
|
| Rate for Payer: BCN Commercial |
$450.72
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.58
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.24
|
| Rate for Payer: UHC Core |
$487.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.42
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$604.88 |
| Max. Negotiated Rate |
$892.59 |
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: BCBS Trust/PPO |
$766.44
|
| Rate for Payer: BCN Commercial |
$766.44
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.42
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.76
|
| Rate for Payer: UHC Core |
$828.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.83
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.55 |
| Max. Negotiated Rate |
$892.59 |
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: Aetna Medicare |
$257.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.93
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$247.94
|
| Rate for Payer: BCBS Trust/PPO |
$771.10
|
| Rate for Payer: BCN Commercial |
$771.10
|
| Rate for Payer: BCN Medicare Advantage |
$247.94
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.94
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.83
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$260.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PACE Senior Care Partners |
$235.55
|
| Rate for Payer: PACE SWMI |
$247.94
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: PHP Medicare Advantage |
$247.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.84
|
| Rate for Payer: Priority Health Medicare |
$247.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.88
|
| Rate for Payer: Railroad Medicare Medicare |
$247.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.76
|
| Rate for Payer: UHC Core |
$828.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.94
|
| Rate for Payer: UHC Medicare Advantage |
$255.38
|
| Rate for Payer: VA VA |
$247.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.83
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$103.02
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.65
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.31
|
| Rate for Payer: UHC Core |
$111.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.98
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
OP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna Medicare |
$34.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.66
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$33.33
|
| Rate for Payer: BCBS Trust/PPO |
$103.65
|
| Rate for Payer: BCN Commercial |
$103.65
|
| Rate for Payer: BCN Medicare Advantage |
$33.33
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.33
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.98
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PACE Senior Care Partners |
$31.66
|
| Rate for Payer: PACE SWMI |
$33.33
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: PHP Medicare Advantage |
$33.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.98
|
| Rate for Payer: Priority Health Medicare |
$33.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.31
|
| Rate for Payer: Railroad Medicare Medicare |
$33.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.31
|
| Rate for Payer: UHC Core |
$111.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.33
|
| Rate for Payer: UHC Medicare Advantage |
$34.33
|
| Rate for Payer: VA VA |
$33.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.98
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$732.32 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: BCBS Trust/PPO |
$927.92
|
| Rate for Payer: BCN Commercial |
$927.92
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.58
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.61
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,044.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.63
|
| Rate for Payer: UHC Core |
$1,002.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.54
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: Aetna Medicare |
$312.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.22
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$300.18
|
| Rate for Payer: BCBS Trust/PPO |
$933.56
|
| Rate for Payer: BCN Commercial |
$933.56
|
| Rate for Payer: BCN Medicare Advantage |
$300.18
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.18
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.54
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$315.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.61
|
| Rate for Payer: PACE Senior Care Partners |
$285.17
|
| Rate for Payer: PACE SWMI |
$300.18
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| Rate for Payer: PHP Medicare Advantage |
$300.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,044.63
|
| Rate for Payer: Priority Health Medicare |
$300.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.32
|
| Rate for Payer: Railroad Medicare Medicare |
$300.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.63
|
| Rate for Payer: UHC Core |
$1,002.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.18
|
| Rate for Payer: UHC Medicare Advantage |
$309.19
|
| Rate for Payer: VA VA |
$300.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.54
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.77 |
| Max. Negotiated Rate |
$240.19 |
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: BCBS Trust/PPO |
$206.24
|
| Rate for Payer: BCN Commercial |
$206.24
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$229.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.50
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.85
|
| Rate for Payer: PHP Commercial |
$226.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.85
|
| Rate for Payer: UHC Core |
$222.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.16
|
|
