|
HC XR SPINE LUMBAR MIN 4 VW
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
32000045
|
|
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 SPINE LUMBAR MIN 4 VW
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
32000045
|
|
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 SPINE LUMB COMP W BEND MIN 6 VW
|
Facility
|
IP
|
$552.23
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
32000046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.81 |
| Max. Negotiated Rate |
$497.01 |
| Rate for Payer: Aetna Commercial |
$469.40
|
| Rate for Payer: BCBS Trust/PPO |
$426.76
|
| Rate for Payer: BCN Commercial |
$426.76
|
| Rate for Payer: Cash Price |
$441.78
|
| Rate for Payer: Cofinity Commercial |
$474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.78
|
| Rate for Payer: Healthscope Commercial |
$497.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.40
|
| Rate for Payer: PHP Commercial |
$469.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.96
|
| Rate for Payer: UHC Core |
$461.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.17
|
|
|
HC XR SPINE LUMB COMP W BEND MIN 6 VW
|
Facility
|
OP
|
$552.23
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
32000046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$497.01 |
| Rate for Payer: Aetna Commercial |
$469.40
|
| Rate for Payer: Aetna Medicare |
$143.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.57
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$138.06
|
| Rate for Payer: BCBS Trust/PPO |
$429.36
|
| Rate for Payer: BCN Commercial |
$429.36
|
| Rate for Payer: BCN Medicare Advantage |
$138.06
|
| Rate for Payer: Cash Price |
$441.78
|
| Rate for Payer: Cash Price |
$441.78
|
| Rate for Payer: Cofinity Commercial |
$474.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.06
|
| Rate for Payer: Healthscope Commercial |
$497.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.17
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.40
|
| Rate for Payer: PACE Senior Care Partners |
$131.15
|
| Rate for Payer: PACE SWMI |
$138.06
|
| Rate for Payer: PHP Commercial |
$469.40
|
| Rate for Payer: PHP Medicare Advantage |
$138.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.44
|
| Rate for Payer: Priority Health Medicare |
$138.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.81
|
| Rate for Payer: Railroad Medicare Medicare |
$138.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.96
|
| Rate for Payer: UHC Core |
$461.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.06
|
| Rate for Payer: UHC Medicare Advantage |
$142.20
|
| Rate for Payer: VA VA |
$138.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.17
|
|
|
HC XR SPINE SINGLE VW
|
Facility
|
IP
|
$184.03
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$165.63 |
| Rate for Payer: Aetna Commercial |
$156.43
|
| Rate for Payer: BCBS Trust/PPO |
$142.22
|
| Rate for Payer: BCN Commercial |
$142.22
|
| Rate for Payer: Cash Price |
$147.22
|
| Rate for Payer: Cofinity Commercial |
$158.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.22
|
| Rate for Payer: Healthscope Commercial |
$165.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.43
|
| Rate for Payer: PHP Commercial |
$156.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.95
|
| Rate for Payer: UHC Core |
$153.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.02
|
|
|
HC XR SPINE SINGLE VW
|
Facility
|
OP
|
$184.03
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$165.63 |
| Rate for Payer: Aetna Commercial |
$156.43
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.51
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$46.01
|
| Rate for Payer: BCBS Trust/PPO |
$143.08
|
| Rate for Payer: BCN Commercial |
$143.08
|
| Rate for Payer: BCN Medicare Advantage |
$46.01
|
| Rate for Payer: Cash Price |
$147.22
|
| Rate for Payer: Cash Price |
$147.22
|
| Rate for Payer: Cofinity Commercial |
$158.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.01
|
| Rate for Payer: Healthscope Commercial |
$165.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.02
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.43
|
| Rate for Payer: PACE Senior Care Partners |
$43.71
|
| Rate for Payer: PACE SWMI |
$46.01
|
| Rate for Payer: PHP Commercial |
$156.43
|
| Rate for Payer: PHP Medicare Advantage |
$46.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.11
|
| Rate for Payer: Priority Health Medicare |
$46.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.24
|
| Rate for Payer: Railroad Medicare Medicare |
$46.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.95
|
| Rate for Payer: UHC Core |
$153.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.01
|
| Rate for Payer: UHC Medicare Advantage |
$47.39
|
| Rate for Payer: VA VA |
$46.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.02
|
|
|
HC XR SPINE THORACIC 2 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
32000039
|
|
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 SPINE THORACIC 2 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
32000039
|
|
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 SPINE THORACIC 3 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
32000040
|
|
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 SPINE THORACIC 3 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
32000040
|
|
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 SPINE THORACIC 4 VW OR MORE
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: BCBS Trust/PPO |
$386.69
|
| Rate for Payer: BCN Commercial |
$386.69
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC XR SPINE THORACIC 4 VW OR MORE
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna Medicare |
$130.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.37
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$125.10
|
| Rate for Payer: BCBS Trust/PPO |
$389.05
|
| Rate for Payer: BCN Commercial |
$389.05
|
| Rate for Payer: BCN Medicare Advantage |
$125.10
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PACE Senior Care Partners |
$118.84
|
| Rate for Payer: PACE SWMI |
$125.10
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: PHP Medicare Advantage |
$125.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Medicare |
$125.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: Railroad Medicare Medicare |
$125.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.10
|
| Rate for Payer: UHC Medicare Advantage |
$128.85
|
| Rate for Payer: VA VA |
$125.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC XR SPINE THORACOLUMBAR 2 VW
|
Facility
|
OP
|
$375.41
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$337.87 |
| Rate for Payer: Aetna Commercial |
$319.10
|
| Rate for Payer: Aetna Medicare |
$97.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.32
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$93.85
|
| Rate for Payer: BCBS Trust/PPO |
$291.88
|
| Rate for Payer: BCN Commercial |
$291.88
|
| Rate for Payer: BCN Medicare Advantage |
$93.85
|
| Rate for Payer: Cash Price |
$300.33
|
| Rate for Payer: Cash Price |
$300.33
|
| Rate for Payer: Cofinity Commercial |
$322.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.85
|
| Rate for Payer: Healthscope Commercial |
$337.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.56
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.10
|
| Rate for Payer: PACE Senior Care Partners |
$89.16
|
| Rate for Payer: PACE SWMI |
$93.85
|
| Rate for Payer: PHP Commercial |
$319.10
|
| Rate for Payer: PHP Medicare Advantage |
$93.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.61
|
| Rate for Payer: Priority Health Medicare |
$93.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.96
|
| Rate for Payer: Railroad Medicare Medicare |
$93.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.36
|
| Rate for Payer: UHC Core |
$313.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.85
|
| Rate for Payer: UHC Medicare Advantage |
$96.67
|
| Rate for Payer: VA VA |
$93.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.56
|
|
|
HC XR SPINE THORACOLUMBAR 2 VW
|
Facility
|
IP
|
$375.41
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
32000042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.96 |
| Max. Negotiated Rate |
$337.87 |
| Rate for Payer: Aetna Commercial |
$319.10
|
| Rate for Payer: BCBS Trust/PPO |
$290.12
|
| Rate for Payer: BCN Commercial |
$290.12
|
| Rate for Payer: Cash Price |
$300.33
|
| Rate for Payer: Cofinity Commercial |
$322.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.33
|
| Rate for Payer: Healthscope Commercial |
$337.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.10
|
| Rate for Payer: PHP Commercial |
$319.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.36
|
| Rate for Payer: UHC Core |
$313.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.56
|
|
|
HC XR STERNOCLAV JTS MIN 3 VW
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
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 STERNOCLAV JTS MIN 3 VW
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
32000032
|
|
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 STERNUM MIN 2 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
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 STERNUM MIN 2 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
32000031
|
|
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 SWALLOWING FUNC W CINE VIDE
|
Facility
|
IP
|
$570.58
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$513.52 |
| Rate for Payer: Aetna Commercial |
$484.99
|
| Rate for Payer: BCBS Trust/PPO |
$440.94
|
| Rate for Payer: BCN Commercial |
$440.94
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cofinity Commercial |
$490.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.46
|
| Rate for Payer: Healthscope Commercial |
$513.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.99
|
| Rate for Payer: PHP Commercial |
$484.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.11
|
| Rate for Payer: UHC Core |
$476.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.94
|
|
|
HC XR SWALLOWING FUNC W CINE VIDE
|
Facility
|
OP
|
$570.58
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$513.52 |
| Rate for Payer: Aetna Commercial |
$484.99
|
| Rate for Payer: Aetna Medicare |
$148.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.31
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$142.64
|
| Rate for Payer: BCBS Trust/PPO |
$443.63
|
| Rate for Payer: BCN Commercial |
$443.63
|
| Rate for Payer: BCN Medicare Advantage |
$142.64
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cash Price |
$456.46
|
| Rate for Payer: Cofinity Commercial |
$490.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.64
|
| Rate for Payer: Healthscope Commercial |
$513.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.94
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.99
|
| Rate for Payer: PACE Senior Care Partners |
$135.51
|
| Rate for Payer: PACE SWMI |
$142.64
|
| Rate for Payer: PHP Commercial |
$484.99
|
| Rate for Payer: PHP Medicare Advantage |
$142.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.40
|
| Rate for Payer: Priority Health Medicare |
$142.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.00
|
| Rate for Payer: Railroad Medicare Medicare |
$142.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.11
|
| Rate for Payer: UHC Core |
$476.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.64
|
| Rate for Payer: UHC Medicare Advantage |
$146.92
|
| Rate for Payer: VA VA |
$142.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.94
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
OP
|
$219.46
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$197.51 |
| Rate for Payer: Aetna Commercial |
$186.54
|
| Rate for Payer: Aetna Medicare |
$57.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.58
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$54.86
|
| Rate for Payer: BCBS Trust/PPO |
$170.63
|
| Rate for Payer: BCN Commercial |
$170.63
|
| Rate for Payer: BCN Medicare Advantage |
$54.86
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$188.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.86
|
| Rate for Payer: Healthscope Commercial |
$197.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.60
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.54
|
| Rate for Payer: PACE Senior Care Partners |
$52.12
|
| Rate for Payer: PACE SWMI |
$54.86
|
| Rate for Payer: PHP Commercial |
$186.54
|
| Rate for Payer: PHP Medicare Advantage |
$54.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.93
|
| Rate for Payer: Priority Health Medicare |
$54.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.85
|
| Rate for Payer: Railroad Medicare Medicare |
$54.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.86
|
| Rate for Payer: UHC Medicare Advantage |
$56.51
|
| Rate for Payer: VA VA |
$54.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.60
|
|
|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
IP
|
$219.46
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$197.51 |
| Rate for Payer: Aetna Commercial |
$186.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.60
|
| Rate for Payer: BCN Commercial |
$169.60
|
| Rate for Payer: Cash Price |
$175.57
|
| Rate for Payer: Cofinity Commercial |
$188.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.57
|
| Rate for Payer: Healthscope Commercial |
$197.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.54
|
| Rate for Payer: PHP Commercial |
$186.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Core |
$183.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.60
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
OP
|
$165.96
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Aetna Commercial |
$141.07
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.86
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$41.49
|
| Rate for Payer: BCBS Trust/PPO |
$129.03
|
| Rate for Payer: BCN Commercial |
$129.03
|
| Rate for Payer: BCN Medicare Advantage |
$41.49
|
| Rate for Payer: Cash Price |
$132.77
|
| Rate for Payer: Cash Price |
$132.77
|
| Rate for Payer: Cofinity Commercial |
$142.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.49
|
| Rate for Payer: Healthscope Commercial |
$149.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.47
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.07
|
| Rate for Payer: PACE Senior Care Partners |
$39.42
|
| Rate for Payer: PACE SWMI |
$41.49
|
| Rate for Payer: PHP Commercial |
$141.07
|
| Rate for Payer: PHP Medicare Advantage |
$41.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.39
|
| Rate for Payer: Priority Health Medicare |
$41.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.22
|
| Rate for Payer: Railroad Medicare Medicare |
$41.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.04
|
| Rate for Payer: UHC Core |
$138.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.49
|
| Rate for Payer: UHC Medicare Advantage |
$42.73
|
| Rate for Payer: VA VA |
$41.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.47
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
IP
|
$165.96
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$149.36 |
| Rate for Payer: Aetna Commercial |
$141.07
|
| Rate for Payer: BCBS Trust/PPO |
$128.25
|
| Rate for Payer: BCN Commercial |
$128.25
|
| Rate for Payer: Cash Price |
$132.77
|
| Rate for Payer: Cofinity Commercial |
$142.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.77
|
| Rate for Payer: Healthscope Commercial |
$149.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.07
|
| Rate for Payer: PHP Commercial |
$141.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.04
|
| Rate for Payer: UHC Core |
$138.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.47
|
|
|
HC XR TIB FIB 2 VIEWS
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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
|
|
