|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| 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 |
$75.72
|
| 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 |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| 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 |
$72.12
|
| 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 SACROILIAC JTS 3 VW OR MORE
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
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 SCAPULA
|
Facility
|
IP
|
$360.36
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.78 |
| Max. Negotiated Rate |
$324.32 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: BCBS Trust/PPO |
$278.49
|
| Rate for Payer: BCN Commercial |
$278.49
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$309.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.29
|
| Rate for Payer: Healthscope Commercial |
$324.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.31
|
| Rate for Payer: PHP Commercial |
$306.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.12
|
| Rate for Payer: UHC Core |
$300.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.27
|
|
|
HC XR SCAPULA
|
Facility
|
OP
|
$360.36
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$324.32 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna Medicare |
$93.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.61
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$90.09
|
| Rate for Payer: BCBS Trust/PPO |
$280.18
|
| Rate for Payer: BCN Commercial |
$280.18
|
| Rate for Payer: BCN Medicare Advantage |
$90.09
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cash Price |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$309.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.09
|
| Rate for Payer: Healthscope Commercial |
$324.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.27
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.31
|
| Rate for Payer: PACE Senior Care Partners |
$85.59
|
| Rate for Payer: PACE SWMI |
$90.09
|
| Rate for Payer: PHP Commercial |
$306.31
|
| Rate for Payer: PHP Medicare Advantage |
$90.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.51
|
| Rate for Payer: Priority Health Medicare |
$90.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.78
|
| Rate for Payer: Railroad Medicare Medicare |
$90.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.12
|
| Rate for Payer: UHC Core |
$300.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.09
|
| Rate for Payer: UHC Medicare Advantage |
$92.79
|
| Rate for Payer: VA VA |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.27
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.97 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$231.84
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.25
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC XR SELLA TURCICA
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
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 SELLA TURCICA
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
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 SHOULDER 1 VW
|
Facility
|
OP
|
$130.16
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$117.14 |
| Rate for Payer: Aetna Commercial |
$110.64
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.68
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$32.54
|
| Rate for Payer: BCBS Trust/PPO |
$101.20
|
| Rate for Payer: BCN Commercial |
$101.20
|
| Rate for Payer: BCN Medicare Advantage |
$32.54
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$117.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.62
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: PACE Senior Care Partners |
$30.91
|
| Rate for Payer: PACE SWMI |
$32.54
|
| Rate for Payer: PHP Commercial |
$110.64
|
| Rate for Payer: PHP Medicare Advantage |
$32.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.24
|
| Rate for Payer: Priority Health Medicare |
$32.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.38
|
| Rate for Payer: Railroad Medicare Medicare |
$32.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Core |
$108.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.54
|
| Rate for Payer: UHC Medicare Advantage |
$33.52
|
| Rate for Payer: VA VA |
$32.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.62
|
|
|
HC XR SHOULDER 1 VW
|
Facility
|
IP
|
$130.16
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$117.14 |
| Rate for Payer: Aetna Commercial |
$110.64
|
| Rate for Payer: BCBS Trust/PPO |
$100.59
|
| Rate for Payer: BCN Commercial |
$100.59
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.13
|
| Rate for Payer: Healthscope Commercial |
$117.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: PHP Commercial |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Core |
$108.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.62
|
|
|
HC XR SHOULDER 1 VW BILATERAL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.19 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.56
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$61.25
|
| Rate for Payer: BCBS Trust/PPO |
$190.49
|
| Rate for Payer: BCN Commercial |
$190.49
|
| Rate for Payer: BCN Medicare Advantage |
$61.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.25
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Senior Care Partners |
$58.19
|
| Rate for Payer: PACE SWMI |
$61.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: PHP Medicare Advantage |
$61.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Medicare |
$61.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: Railroad Medicare Medicare |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.25
|
| Rate for Payer: UHC Medicare Advantage |
$63.09
|
| Rate for Payer: VA VA |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
HC XR SHOULDER 1 VW BILATERAL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: BCBS Trust/PPO |
$189.34
|
| Rate for Payer: BCN Commercial |
$189.34
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
HC XR SHOULDER BIL 1 VW
|
Facility
|
OP
|
$171.64
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$154.48 |
| Rate for Payer: Aetna Commercial |
$145.89
|
| Rate for Payer: Aetna Medicare |
$44.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.64
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$42.91
|
| Rate for Payer: BCBS Trust/PPO |
$133.45
|
| Rate for Payer: BCN Commercial |
$133.45
|
| Rate for Payer: BCN Medicare Advantage |
$42.91
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cofinity Commercial |
$147.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.91
|
| Rate for Payer: Healthscope Commercial |
$154.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.73
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.89
|
| Rate for Payer: PACE Senior Care Partners |
$40.76
|
| Rate for Payer: PACE SWMI |
$42.91
|
| Rate for Payer: PHP Commercial |
$145.89
|
| Rate for Payer: PHP Medicare Advantage |
$42.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.33
|
| Rate for Payer: Priority Health Medicare |
$42.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: Railroad Medicare Medicare |
$42.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.04
|
| Rate for Payer: UHC Core |
$143.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.91
|
| Rate for Payer: UHC Medicare Advantage |
$44.20
|
| Rate for Payer: VA VA |
$42.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.73
|
|
|
HC XR SHOULDER BIL 1 VW
|
Facility
|
IP
|
$171.64
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.68 |
| Max. Negotiated Rate |
$154.48 |
| Rate for Payer: Aetna Commercial |
$145.89
|
| Rate for Payer: BCBS Trust/PPO |
$132.64
|
| Rate for Payer: BCN Commercial |
$132.64
|
| Rate for Payer: Cash Price |
$137.31
|
| Rate for Payer: Cofinity Commercial |
$147.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.31
|
| Rate for Payer: Healthscope Commercial |
$154.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.89
|
| Rate for Payer: PHP Commercial |
$145.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.04
|
| Rate for Payer: UHC Core |
$143.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.73
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
IP
|
$442.79
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.06 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna Commercial |
$376.37
|
| Rate for Payer: BCBS Trust/PPO |
$342.19
|
| Rate for Payer: BCN Commercial |
$342.19
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.23
|
| Rate for Payer: Healthscope Commercial |
$398.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.37
|
| Rate for Payer: PHP Commercial |
$376.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.66
|
| Rate for Payer: UHC Core |
$369.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.09
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
OP
|
$442.79
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$398.51 |
| Rate for Payer: Aetna Commercial |
$376.37
|
| Rate for Payer: Aetna Medicare |
$115.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.37
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$110.70
|
| Rate for Payer: BCBS Trust/PPO |
$344.27
|
| Rate for Payer: BCN Commercial |
$344.27
|
| Rate for Payer: BCN Medicare Advantage |
$110.70
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cash Price |
$354.23
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.70
|
| Rate for Payer: Healthscope Commercial |
$398.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.09
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.37
|
| Rate for Payer: PACE Senior Care Partners |
$105.16
|
| Rate for Payer: PACE SWMI |
$110.70
|
| Rate for Payer: PHP Commercial |
$376.37
|
| Rate for Payer: PHP Medicare Advantage |
$110.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.23
|
| Rate for Payer: Priority Health Medicare |
$110.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.06
|
| Rate for Payer: Railroad Medicare Medicare |
$110.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.66
|
| Rate for Payer: UHC Core |
$369.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.70
|
| Rate for Payer: UHC Medicare Advantage |
$114.02
|
| Rate for Payer: VA VA |
$110.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.09
|
|
|
HC XR SHOULDER MIN 2 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
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 SHOULDER MIN 2 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
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 SINUSES LESS THAN 3 VW
|
Facility
|
OP
|
$200.23
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$180.21 |
| Rate for Payer: Aetna Commercial |
$170.20
|
| Rate for Payer: Aetna Medicare |
$52.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.57
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$50.06
|
| Rate for Payer: BCBS Trust/PPO |
$155.68
|
| Rate for Payer: BCN Commercial |
$155.68
|
| Rate for Payer: BCN Medicare Advantage |
$50.06
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.06
|
| Rate for Payer: Healthscope Commercial |
$180.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.17
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.20
|
| Rate for Payer: PACE Senior Care Partners |
$47.55
|
| Rate for Payer: PACE SWMI |
$50.06
|
| Rate for Payer: PHP Commercial |
$170.20
|
| Rate for Payer: PHP Medicare Advantage |
$50.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.20
|
| Rate for Payer: Priority Health Medicare |
$50.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.12
|
| Rate for Payer: Railroad Medicare Medicare |
$50.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.20
|
| Rate for Payer: UHC Core |
$167.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.06
|
| Rate for Payer: UHC Medicare Advantage |
$51.56
|
| Rate for Payer: VA VA |
$50.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.17
|
|
|
HC XR SINUSES LESS THAN 3 VW
|
Facility
|
IP
|
$200.23
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.12 |
| Max. Negotiated Rate |
$180.21 |
| Rate for Payer: Aetna Commercial |
$170.20
|
| Rate for Payer: BCBS Trust/PPO |
$154.74
|
| Rate for Payer: BCN Commercial |
$154.74
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.20
|
| Rate for Payer: PHP Commercial |
$170.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.20
|
| Rate for Payer: UHC Core |
$167.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.17
|
|
|
HC XR SINUSES MIN 3 VW
|
Facility
|
OP
|
$350.63
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$315.57 |
| Rate for Payer: Aetna Commercial |
$298.04
|
| Rate for Payer: Aetna Medicare |
$91.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.57
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$87.66
|
| Rate for Payer: BCBS Trust/PPO |
$272.61
|
| Rate for Payer: BCN Commercial |
$272.61
|
| Rate for Payer: BCN Medicare Advantage |
$87.66
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cofinity Commercial |
$301.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.66
|
| Rate for Payer: Healthscope Commercial |
$315.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.97
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.04
|
| Rate for Payer: PACE Senior Care Partners |
$83.27
|
| Rate for Payer: PACE SWMI |
$87.66
|
| Rate for Payer: PHP Commercial |
$298.04
|
| Rate for Payer: PHP Medicare Advantage |
$87.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.05
|
| Rate for Payer: Priority Health Medicare |
$87.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.85
|
| Rate for Payer: Railroad Medicare Medicare |
$87.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.55
|
| Rate for Payer: UHC Core |
$292.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.66
|
| Rate for Payer: UHC Medicare Advantage |
$90.29
|
| Rate for Payer: VA VA |
$87.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.97
|
|
|
HC XR SINUSES MIN 3 VW
|
Facility
|
IP
|
$350.63
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$315.57 |
| Rate for Payer: Aetna Commercial |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$270.97
|
| Rate for Payer: BCN Commercial |
$270.97
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cofinity Commercial |
$301.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.50
|
| Rate for Payer: Healthscope Commercial |
$315.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.04
|
| Rate for Payer: PHP Commercial |
$298.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.55
|
| Rate for Payer: UHC Core |
$292.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.97
|
|
|
HC XR SINUS TRACT FISTULA ABSCESS
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.43 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: BCBS Trust/PPO |
$294.51
|
| Rate for Payer: BCN Commercial |
$294.51
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
