|
HC XR TIB FIB 2 VIEWS
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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 TIB FIB BIL 2 VW
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
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
|
|
|
HC XR TIB FIB BIL 2 VW
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna Medicare |
$99.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.09
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$95.27
|
| Rate for Payer: BCBS Trust/PPO |
$296.30
|
| Rate for Payer: BCN Commercial |
$296.30
|
| Rate for Payer: BCN Medicare Advantage |
$95.27
|
| Rate for Payer: Cash Price |
$304.87
|
| 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: Health Alliance Plan Medicare Advantage |
$95.27
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PACE Senior Care Partners |
$90.51
|
| Rate for Payer: PACE SWMI |
$95.27
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: PHP Medicare Advantage |
$95.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| 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 Medicare |
$95.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: Railroad Medicare Medicare |
$95.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.27
|
| Rate for Payer: UHC Medicare Advantage |
$98.13
|
| Rate for Payer: VA VA |
$95.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC XR TMJ COMPLETE BIL
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ COMPLETE BIL
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ LTD
|
Facility
|
OP
|
$109.41
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare |
$28.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.19
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$27.35
|
| Rate for Payer: BCBS Trust/PPO |
$85.07
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: BCN Medicare Advantage |
$27.35
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PACE Senior Care Partners |
$25.98
|
| Rate for Payer: PACE SWMI |
$27.35
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.19
|
| Rate for Payer: Priority Health Medicare |
$27.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.73
|
| Rate for Payer: Railroad Medicare Medicare |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.28
|
| Rate for Payer: UHC Core |
$91.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.35
|
| Rate for Payer: UHC Medicare Advantage |
$28.17
|
| Rate for Payer: VA VA |
$27.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR TMJ LTD
|
Facility
|
IP
|
$109.41
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: BCBS Trust/PPO |
$84.55
|
| Rate for Payer: BCN Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.28
|
| Rate for Payer: UHC Core |
$91.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR TOES BIL MIN 2 VIEWS
|
Facility
|
OP
|
$219.46
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
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 |
$62.59
|
| 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 |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| 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 |
$59.61
|
| 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 TOES BIL MIN 2 VIEWS
|
Facility
|
IP
|
$219.46
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
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 TOES MIN 2 VIEWS
|
Facility
|
IP
|
$190.24
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$171.22 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: BCBS Trust/PPO |
$147.02
|
| Rate for Payer: BCN Commercial |
$147.02
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.19
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.70
|
| Rate for Payer: PHP Commercial |
$161.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.41
|
| Rate for Payer: UHC Core |
$158.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.68
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
OP
|
$190.24
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$171.22 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Aetna Medicare |
$49.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.45
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$47.56
|
| Rate for Payer: BCBS Trust/PPO |
$147.91
|
| Rate for Payer: BCN Commercial |
$147.91
|
| Rate for Payer: BCN Medicare Advantage |
$47.56
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cash Price |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$163.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.56
|
| Rate for Payer: Healthscope Commercial |
$171.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.68
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.70
|
| Rate for Payer: PACE Senior Care Partners |
$45.18
|
| Rate for Payer: PACE SWMI |
$47.56
|
| Rate for Payer: PHP Commercial |
$161.70
|
| Rate for Payer: PHP Medicare Advantage |
$47.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.51
|
| Rate for Payer: Priority Health Medicare |
$47.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.03
|
| Rate for Payer: Railroad Medicare Medicare |
$47.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.41
|
| Rate for Payer: UHC Core |
$158.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.56
|
| Rate for Payer: UHC Medicare Advantage |
$48.99
|
| Rate for Payer: VA VA |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.68
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$222.46
|
| Rate for Payer: BCN Commercial |
$222.46
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: BCBS Trust/PPO |
$221.11
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC XR UPPER GI
|
Facility
|
OP
|
$572.10
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$514.89 |
| Rate for Payer: Aetna Commercial |
$486.28
|
| Rate for Payer: Aetna Medicare |
$148.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.78
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$143.02
|
| Rate for Payer: BCBS Trust/PPO |
$444.81
|
| Rate for Payer: BCN Commercial |
$444.81
|
| Rate for Payer: BCN Medicare Advantage |
$143.02
|
| Rate for Payer: Cash Price |
$457.68
|
| Rate for Payer: Cash Price |
$457.68
|
| Rate for Payer: Cofinity Commercial |
$492.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.02
|
| Rate for Payer: Healthscope Commercial |
$514.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.08
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.28
|
| Rate for Payer: PACE Senior Care Partners |
$135.87
|
| Rate for Payer: PACE SWMI |
$143.02
|
| Rate for Payer: PHP Commercial |
$486.28
|
| Rate for Payer: PHP Medicare Advantage |
$143.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.73
|
| Rate for Payer: Priority Health Medicare |
$143.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.92
|
| Rate for Payer: Railroad Medicare Medicare |
$143.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.45
|
| Rate for Payer: UHC Core |
$477.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.02
|
| Rate for Payer: UHC Medicare Advantage |
$147.32
|
| Rate for Payer: VA VA |
$143.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.08
|
|
|
HC XR UPPER GI
|
Facility
|
IP
|
$572.10
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$514.89 |
| Rate for Payer: Aetna Commercial |
$486.28
|
| Rate for Payer: BCBS Trust/PPO |
$442.12
|
| Rate for Payer: BCN Commercial |
$442.12
|
| Rate for Payer: Cash Price |
$457.68
|
| Rate for Payer: Cofinity Commercial |
$492.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.68
|
| Rate for Payer: Healthscope Commercial |
$514.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.28
|
| Rate for Payer: PHP Commercial |
$486.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.45
|
| Rate for Payer: UHC Core |
$477.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.08
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: Aetna Medicare |
$124.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.00
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$373.20
|
| Rate for Payer: BCN Commercial |
$373.20
|
| Rate for Payer: BCN Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$432.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.00
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.00
|
| Rate for Payer: PACE Senior Care Partners |
$114.00
|
| Rate for Payer: PACE SWMI |
$120.00
|
| Rate for Payer: PHP Commercial |
$408.00
|
| Rate for Payer: PHP Medicare Advantage |
$120.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.60
|
| Rate for Payer: Priority Health Medicare |
$120.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.75
|
| Rate for Payer: Railroad Medicare Medicare |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.40
|
| Rate for Payer: UHC Core |
$400.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.00
|
| Rate for Payer: UHC Medicare Advantage |
$123.60
|
| Rate for Payer: VA VA |
$120.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.00
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: BCBS Trust/PPO |
$370.94
|
| Rate for Payer: BCN Commercial |
$370.94
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.00
|
| Rate for Payer: Healthscope Commercial |
$432.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.00
|
| Rate for Payer: PHP Commercial |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.40
|
| Rate for Payer: UHC Core |
$400.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.00
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
IP
|
$777.33
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$474.09 |
| Max. Negotiated Rate |
$699.60 |
| Rate for Payer: Aetna Commercial |
$660.73
|
| Rate for Payer: BCBS Trust/PPO |
$600.72
|
| Rate for Payer: BCN Commercial |
$600.72
|
| Rate for Payer: Cash Price |
$621.86
|
| Rate for Payer: Cofinity Commercial |
$668.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.86
|
| Rate for Payer: Healthscope Commercial |
$699.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.73
|
| Rate for Payer: PHP Commercial |
$660.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.05
|
| Rate for Payer: UHC Core |
$649.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.00
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
OP
|
$777.33
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$699.60 |
| Rate for Payer: Aetna Commercial |
$660.73
|
| Rate for Payer: Aetna Medicare |
$202.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.92
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$194.33
|
| Rate for Payer: BCBS Trust/PPO |
$604.37
|
| Rate for Payer: BCN Commercial |
$604.37
|
| Rate for Payer: BCN Medicare Advantage |
$194.33
|
| Rate for Payer: Cash Price |
$621.86
|
| Rate for Payer: Cash Price |
$621.86
|
| Rate for Payer: Cofinity Commercial |
$668.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.33
|
| Rate for Payer: Healthscope Commercial |
$699.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.00
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.73
|
| Rate for Payer: PACE Senior Care Partners |
$184.62
|
| Rate for Payer: PACE SWMI |
$194.33
|
| Rate for Payer: PHP Commercial |
$660.73
|
| Rate for Payer: PHP Medicare Advantage |
$194.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.28
|
| Rate for Payer: Priority Health Medicare |
$194.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.09
|
| Rate for Payer: Railroad Medicare Medicare |
$194.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.05
|
| Rate for Payer: UHC Core |
$649.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.33
|
| Rate for Payer: UHC Medicare Advantage |
$200.16
|
| Rate for Payer: VA VA |
$194.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.00
|
|
|
HC XR WRIST 2 VW
|
Facility
|
IP
|
$250.45
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.75 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: BCBS Trust/PPO |
$193.55
|
| Rate for Payer: BCN Commercial |
$193.55
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.36
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.88
|
| Rate for Payer: PHP Commercial |
$212.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.40
|
| Rate for Payer: UHC Core |
$209.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.84
|
|
|
HC XR WRIST 2 VW
|
Facility
|
OP
|
$250.45
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Aetna Medicare |
$65.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.27
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$62.61
|
| Rate for Payer: BCBS Trust/PPO |
$194.72
|
| Rate for Payer: BCN Commercial |
$194.72
|
| Rate for Payer: BCN Medicare Advantage |
$62.61
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.61
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.84
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.88
|
| Rate for Payer: PACE Senior Care Partners |
$59.48
|
| Rate for Payer: PACE SWMI |
$62.61
|
| Rate for Payer: PHP Commercial |
$212.88
|
| Rate for Payer: PHP Medicare Advantage |
$62.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.89
|
| Rate for Payer: Priority Health Medicare |
$62.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.75
|
| Rate for Payer: Railroad Medicare Medicare |
$62.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.40
|
| Rate for Payer: UHC Core |
$209.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.61
|
| Rate for Payer: UHC Medicare Advantage |
$64.49
|
| Rate for Payer: VA VA |
$62.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.84
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$222.46
|
| Rate for Payer: BCN Commercial |
$222.46
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC XR WRIST BIL 2 VW
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: BCBS Trust/PPO |
$221.11
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC XR WRIST BIL MIN 3 VW
|
Facility
|
IP
|
$442.79
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
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 WRIST BIL MIN 3 VW
|
Facility
|
OP
|
$442.79
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
32000083
|
|
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
|
|
