|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$240.19 |
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: Aetna Medicare |
$69.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.40
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$66.72
|
| Rate for Payer: BCBS Trust/PPO |
$207.50
|
| Rate for Payer: BCN Commercial |
$207.50
|
| Rate for Payer: BCN Medicare Advantage |
$66.72
|
| Rate for Payer: Cash Price |
$213.50
|
| 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: Health Alliance Plan Medicare Advantage |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.16
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.85
|
| Rate for Payer: PACE Senior Care Partners |
$63.38
|
| Rate for Payer: PACE SWMI |
$66.72
|
| Rate for Payer: PHP Commercial |
$226.85
|
| Rate for Payer: PHP Medicare Advantage |
$66.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| 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 Medicare |
$66.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.77
|
| Rate for Payer: Railroad Medicare Medicare |
$66.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.85
|
| Rate for Payer: UHC Core |
$222.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.72
|
| Rate for Payer: UHC Medicare Advantage |
$68.72
|
| Rate for Payer: VA VA |
$66.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.16
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: Aetna Medicare |
$88.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.29
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$85.03
|
| Rate for Payer: BCBS Trust/PPO |
$264.44
|
| Rate for Payer: BCN Commercial |
$264.44
|
| Rate for Payer: BCN Medicare Advantage |
$85.03
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.03
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.09
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PACE Senior Care Partners |
$80.78
|
| Rate for Payer: PACE SWMI |
$85.03
|
| Rate for Payer: PHP Commercial |
$289.10
|
| Rate for Payer: PHP Medicare Advantage |
$85.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.90
|
| Rate for Payer: Priority Health Medicare |
$85.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.44
|
| Rate for Payer: Railroad Medicare Medicare |
$85.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.31
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.03
|
| Rate for Payer: UHC Medicare Advantage |
$87.58
|
| Rate for Payer: VA VA |
$85.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.09
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.44 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: BCBS Trust/PPO |
$262.84
|
| Rate for Payer: BCN Commercial |
$262.84
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PHP Commercial |
$289.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.31
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.09
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
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 OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
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 OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.23 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: BCBS Trust/PPO |
$232.16
|
| Rate for Payer: BCN Commercial |
$232.16
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.37
|
| Rate for Payer: UHC Core |
$250.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna Medicare |
$78.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.88
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$233.58
|
| Rate for Payer: BCN Commercial |
$233.58
|
| Rate for Payer: BCN Medicare Advantage |
$75.10
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.10
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PACE Senior Care Partners |
$71.35
|
| Rate for Payer: PACE SWMI |
$75.10
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$75.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.37
|
| Rate for Payer: Priority Health Medicare |
$75.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$75.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.37
|
| Rate for Payer: UHC Core |
$250.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.10
|
| Rate for Payer: UHC Medicare Advantage |
$77.36
|
| Rate for Payer: VA VA |
$75.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$261.48 |
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: Aetna Medicare |
$75.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.79
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$72.63
|
| Rate for Payer: BCBS Trust/PPO |
$225.89
|
| Rate for Payer: BCN Commercial |
$225.89
|
| Rate for Payer: BCN Medicare Advantage |
$72.63
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.63
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.90
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.95
|
| Rate for Payer: PACE Senior Care Partners |
$69.00
|
| Rate for Payer: PACE SWMI |
$72.63
|
| Rate for Payer: PHP Commercial |
$246.95
|
| Rate for Payer: PHP Medicare Advantage |
$72.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.76
|
| Rate for Payer: Priority Health Medicare |
$72.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.19
|
| Rate for Payer: Railroad Medicare Medicare |
$72.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.67
|
| Rate for Payer: UHC Core |
$242.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.63
|
| Rate for Payer: UHC Medicare Advantage |
$74.81
|
| Rate for Payer: VA VA |
$72.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.90
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$261.48 |
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: BCBS Trust/PPO |
$224.52
|
| Rate for Payer: BCN Commercial |
$224.52
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.42
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.95
|
| Rate for Payer: PHP Commercial |
$246.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.67
|
| Rate for Payer: UHC Core |
$242.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.90
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
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 PELVIS MIN 3 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
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 PYELOGRAPHY IV
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$260.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.74
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.09
|
| Rate for Payer: BCN Commercial |
$778.09
|
| Rate for Payer: BCN Medicare Advantage |
$250.19
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Senior Care Partners |
$237.68
|
| Rate for Payer: PACE SWMI |
$250.19
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$250.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Medicare |
$250.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: Railroad Medicare Medicare |
$250.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.19
|
| Rate for Payer: UHC Medicare Advantage |
$257.70
|
| Rate for Payer: VA VA |
$250.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$610.36 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: BCBS Trust/PPO |
$773.39
|
| Rate for Payer: BCN Commercial |
$773.39
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,300.78
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,170.70 |
| Rate for Payer: Aetna Commercial |
$1,105.66
|
| Rate for Payer: Aetna Medicare |
$338.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.49
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$325.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.36
|
| Rate for Payer: BCN Commercial |
$1,011.36
|
| Rate for Payer: BCN Medicare Advantage |
$325.20
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,118.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.20
|
| Rate for Payer: Healthscope Commercial |
$1,170.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.58
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$341.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: PACE Senior Care Partners |
$308.94
|
| Rate for Payer: PACE SWMI |
$325.20
|
| Rate for Payer: PHP Commercial |
$1,105.66
|
| Rate for Payer: PHP Medicare Advantage |
$325.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.68
|
| Rate for Payer: Priority Health Medicare |
$325.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.35
|
| Rate for Payer: Railroad Medicare Medicare |
$325.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.69
|
| Rate for Payer: UHC Core |
$1,086.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.20
|
| Rate for Payer: UHC Medicare Advantage |
$334.95
|
| Rate for Payer: VA VA |
$325.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.58
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
IP
|
$1,300.78
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$793.35 |
| Max. Negotiated Rate |
$1,170.70 |
| Rate for Payer: Aetna Commercial |
$1,105.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.24
|
| Rate for Payer: BCN Commercial |
$1,005.24
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,118.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Healthscope Commercial |
$1,170.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: PHP Commercial |
$1,105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.69
|
| Rate for Payer: UHC Core |
$1,086.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.58
|
|
|
HC XR RIBS 2 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: BCBS Trust/PPO |
$270.77
|
| Rate for Payer: BCN Commercial |
$270.77
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC XR RIBS 2 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$91.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.49
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$87.59
|
| Rate for Payer: BCBS Trust/PPO |
$272.41
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: BCN Medicare Advantage |
$87.59
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.59
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Senior Care Partners |
$83.21
|
| Rate for Payer: PACE SWMI |
$87.59
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: PHP Medicare Advantage |
$87.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Medicare |
$87.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: Railroad Medicare Medicare |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.59
|
| Rate for Payer: UHC Medicare Advantage |
$90.22
|
| Rate for Payer: VA VA |
$87.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
OP
|
$450.54
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
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 RIBS BIL INCL PA CHST
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
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 RIBS BIL MIN 3 VW
|
Facility
|
OP
|
$450.54
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
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 RIBS BIL MIN 3 VW
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
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 RIBS INC PA CHST
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
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 RIBS INC PA CHST
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
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 SACROILIAC JTS 3 VW OR LESS
|
Facility
|
IP
|
$185.06
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.87 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: BCBS Trust/PPO |
$143.01
|
| Rate for Payer: BCN Commercial |
$143.01
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.30
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.85
|
| Rate for Payer: UHC Core |
$154.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.80
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
OP
|
$185.06
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.83
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$143.88
|
| Rate for Payer: BCN Commercial |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$46.26
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.80
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.30
|
| Rate for Payer: PACE Senior Care Partners |
$43.95
|
| Rate for Payer: PACE SWMI |
$46.26
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: PHP Medicare Advantage |
$46.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.00
|
| Rate for Payer: Priority Health Medicare |
$46.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.87
|
| Rate for Payer: Railroad Medicare Medicare |
$46.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.85
|
| Rate for Payer: UHC Core |
$154.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.26
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
| Rate for Payer: VA VA |
$46.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.80
|
|
