|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,249.22
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$869.46 |
| Max. Negotiated Rate |
$1,124.30 |
| Rate for Payer: Aetna Commercial |
$1,061.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.73
|
| Rate for Payer: BCN Commercial |
$1,031.73
|
| Rate for Payer: Cash Price |
$999.38
|
| Rate for Payer: Cofinity Commercial |
$1,074.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$999.38
|
| Rate for Payer: Healthscope Commercial |
$1,124.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$936.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.84
|
| Rate for Payer: Nomi Health Commercial |
$1,024.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.91
|
| Rate for Payer: PHP Commercial |
$1,061.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,086.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$869.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.31
|
| Rate for Payer: UHC Core |
$1,043.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$936.91
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,249.22
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.24 |
| Max. Negotiated Rate |
$1,124.30 |
| Rate for Payer: Aetna Commercial |
$1,061.84
|
| Rate for Payer: Aetna Medicare |
$324.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$390.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$390.38
|
| Rate for Payer: BCBS Complete |
$231.23
|
| Rate for Payer: BCBS MAPPO |
$312.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,026.98
|
| Rate for Payer: BCN Commercial |
$1,026.98
|
| Rate for Payer: BCN Medicare Advantage |
$312.31
|
| Rate for Payer: Cash Price |
$999.38
|
| Rate for Payer: Cofinity Commercial |
$1,074.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$999.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.31
|
| Rate for Payer: Healthscope Commercial |
$1,124.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$936.91
|
| Rate for Payer: Mclaren Medicaid |
$220.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.92
|
| Rate for Payer: Meridian Medicaid |
$231.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$343.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.84
|
| Rate for Payer: Nomi Health Commercial |
$1,024.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.91
|
| Rate for Payer: PACE Senior Care Partners |
$296.69
|
| Rate for Payer: PACE SWMI |
$312.31
|
| Rate for Payer: PHP Commercial |
$1,061.84
|
| Rate for Payer: PHP Medicare Advantage |
$312.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,086.82
|
| Rate for Payer: Priority Health Medicare |
$315.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$869.46
|
| Rate for Payer: Railroad Medicare Medicare |
$312.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.31
|
| Rate for Payer: UHC Core |
$1,043.10
|
| Rate for Payer: UHC Exchange |
$312.31
|
| Rate for Payer: UHC Medicaid |
$220.24
|
| Rate for Payer: UHC Medicare Advantage |
$312.31
|
| Rate for Payer: UHCCP Medicaid |
$220.24
|
| Rate for Payer: VA VA |
$312.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$936.91
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$277.66
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$249.89 |
| Rate for Payer: Aetna Commercial |
$236.01
|
| Rate for Payer: BCBS Trust/PPO |
$229.32
|
| Rate for Payer: BCN Commercial |
$229.32
|
| Rate for Payer: Cash Price |
$222.13
|
| Rate for Payer: Cofinity Commercial |
$238.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.13
|
| Rate for Payer: Healthscope Commercial |
$249.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.01
|
| Rate for Payer: Nomi Health Commercial |
$227.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.25
|
| Rate for Payer: PHP Commercial |
$236.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.34
|
| Rate for Payer: UHC Core |
$231.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.25
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$277.66
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$249.89 |
| Rate for Payer: Aetna Commercial |
$236.01
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.77
|
| Rate for Payer: BCBS Complete |
$51.39
|
| Rate for Payer: BCBS MAPPO |
$69.42
|
| Rate for Payer: BCBS Trust/PPO |
$228.26
|
| Rate for Payer: BCN Commercial |
$228.26
|
| Rate for Payer: BCN Medicare Advantage |
$69.42
|
| Rate for Payer: Cash Price |
$222.13
|
| Rate for Payer: Cofinity Commercial |
$238.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.42
|
| Rate for Payer: Healthscope Commercial |
$249.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.25
|
| Rate for Payer: Mclaren Medicaid |
$48.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.89
|
| Rate for Payer: Meridian Medicaid |
$51.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.01
|
| Rate for Payer: Nomi Health Commercial |
$227.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.25
|
| Rate for Payer: PACE Senior Care Partners |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.42
|
| Rate for Payer: PHP Commercial |
$236.01
|
| Rate for Payer: PHP Medicare Advantage |
$69.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.56
|
| Rate for Payer: Priority Health Medicare |
$70.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.25
|
| Rate for Payer: Railroad Medicare Medicare |
$69.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.34
|
| Rate for Payer: UHC Core |
$231.85
|
| Rate for Payer: UHC Exchange |
$69.42
|
| Rate for Payer: UHC Medicaid |
$48.95
|
| Rate for Payer: UHC Medicare Advantage |
$69.42
|
| Rate for Payer: UHCCP Medicaid |
$48.95
|
| Rate for Payer: VA VA |
$69.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.25
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.39 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.58
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$88.47
|
| Rate for Payer: BCBS Trust/PPO |
$290.91
|
| Rate for Payer: BCN Commercial |
$290.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.47
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.47
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.39
|
| Rate for Payer: Mclaren Medicaid |
$62.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.89
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: Nomi Health Commercial |
$290.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.39
|
| Rate for Payer: PACE Senior Care Partners |
$84.04
|
| Rate for Payer: PACE SWMI |
$88.47
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: PHP Medicare Advantage |
$88.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.86
|
| Rate for Payer: Priority Health Medicare |
$89.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.29
|
| Rate for Payer: Railroad Medicare Medicare |
$88.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.40
|
| Rate for Payer: UHC Core |
$295.47
|
| Rate for Payer: UHC Exchange |
$88.47
|
| Rate for Payer: UHC Medicaid |
$62.39
|
| Rate for Payer: UHC Medicare Advantage |
$88.47
|
| Rate for Payer: UHCCP Medicaid |
$62.39
|
| Rate for Payer: VA VA |
$88.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.39
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$353.86
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.29 |
| Max. Negotiated Rate |
$318.47 |
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: BCBS Trust/PPO |
$292.25
|
| Rate for Payer: BCN Commercial |
$292.25
|
| Rate for Payer: Cash Price |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$304.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.09
|
| Rate for Payer: Healthscope Commercial |
$318.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.78
|
| Rate for Payer: Nomi Health Commercial |
$290.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.39
|
| Rate for Payer: PHP Commercial |
$300.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.40
|
| Rate for Payer: UHC Core |
$295.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.39
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna Medicare |
$90.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.48
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: BCBS MAPPO |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$285.39
|
| Rate for Payer: BCN Commercial |
$285.39
|
| Rate for Payer: BCN Medicare Advantage |
$86.79
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.79
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Mclaren Medicaid |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.13
|
| Rate for Payer: Meridian Medicaid |
$64.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PACE Senior Care Partners |
$82.45
|
| Rate for Payer: PACE SWMI |
$86.79
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: PHP Medicare Advantage |
$86.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Medicare |
$87.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: Railroad Medicare Medicare |
$86.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: UHC Exchange |
$86.79
|
| Rate for Payer: UHC Medicaid |
$61.20
|
| Rate for Payer: UHC Medicare Advantage |
$86.79
|
| Rate for Payer: UHCCP Medicaid |
$61.20
|
| Rate for Payer: VA VA |
$86.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$241.62 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: BCBS Trust/PPO |
$286.71
|
| Rate for Payer: BCN Commercial |
$286.71
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.54 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: BCBS Trust/PPO |
$258.14
|
| Rate for Payer: BCN Commercial |
$258.14
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.05
|
| Rate for Payer: UHC Core |
$260.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.42
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna Commercial |
$265.68
|
| Rate for Payer: Aetna Medicare |
$81.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.67
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCBS Trust/PPO |
$256.96
|
| Rate for Payer: BCN Commercial |
$256.96
|
| Rate for Payer: BCN Medicare Advantage |
$78.14
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$268.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.42
|
| Rate for Payer: Mclaren Medicaid |
$55.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.05
|
| Rate for Payer: Meridian Medicaid |
$57.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PACE Senior Care Partners |
$74.23
|
| Rate for Payer: PACE SWMI |
$78.14
|
| Rate for Payer: PHP Commercial |
$265.68
|
| Rate for Payer: PHP Medicare Advantage |
$78.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.93
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.54
|
| Rate for Payer: Railroad Medicare Medicare |
$78.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.05
|
| Rate for Payer: UHC Core |
$260.99
|
| Rate for Payer: UHC Exchange |
$78.14
|
| Rate for Payer: UHC Medicaid |
$55.10
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| Rate for Payer: UHCCP Medicaid |
$55.10
|
| Rate for Payer: VA VA |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.42
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$302.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$272.04 |
| Rate for Payer: Aetna Commercial |
$256.93
|
| Rate for Payer: BCBS Trust/PPO |
$249.64
|
| Rate for Payer: BCN Commercial |
$249.64
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$259.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.82
|
| Rate for Payer: Healthscope Commercial |
$272.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.93
|
| Rate for Payer: Nomi Health Commercial |
$247.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.70
|
| Rate for Payer: PHP Commercial |
$256.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.00
|
| Rate for Payer: UHC Core |
$252.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.70
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$302.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$272.04 |
| Rate for Payer: Aetna Commercial |
$256.93
|
| Rate for Payer: Aetna Medicare |
$78.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.46
|
| Rate for Payer: BCBS Complete |
$55.95
|
| Rate for Payer: BCBS MAPPO |
$75.57
|
| Rate for Payer: BCBS Trust/PPO |
$248.50
|
| Rate for Payer: BCN Commercial |
$248.50
|
| Rate for Payer: BCN Medicare Advantage |
$75.57
|
| Rate for Payer: Cash Price |
$241.82
|
| Rate for Payer: Cofinity Commercial |
$259.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.57
|
| Rate for Payer: Healthscope Commercial |
$272.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.70
|
| Rate for Payer: Mclaren Medicaid |
$53.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.35
|
| Rate for Payer: Meridian Medicaid |
$55.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.93
|
| Rate for Payer: Nomi Health Commercial |
$247.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.70
|
| Rate for Payer: PACE Senior Care Partners |
$71.79
|
| Rate for Payer: PACE SWMI |
$75.57
|
| Rate for Payer: PHP Commercial |
$256.93
|
| Rate for Payer: PHP Medicare Advantage |
$75.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.97
|
| Rate for Payer: Priority Health Medicare |
$76.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.38
|
| Rate for Payer: Railroad Medicare Medicare |
$75.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.00
|
| Rate for Payer: UHC Core |
$252.40
|
| Rate for Payer: UHC Exchange |
$75.57
|
| Rate for Payer: UHC Medicaid |
$53.29
|
| Rate for Payer: UHC Medicare Advantage |
$75.57
|
| Rate for Payer: UHCCP Medicaid |
$53.29
|
| Rate for Payer: VA VA |
$75.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.70
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.79 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: BCBS Trust/PPO |
$343.87
|
| Rate for Payer: BCN Commercial |
$343.87
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.40
|
| Rate for Payer: UHC Core |
$347.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.27
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: Aetna Medicare |
$108.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.11
|
| Rate for Payer: BCBS Complete |
$77.07
|
| Rate for Payer: BCBS MAPPO |
$104.09
|
| Rate for Payer: BCBS Trust/PPO |
$342.29
|
| Rate for Payer: BCN Commercial |
$342.29
|
| Rate for Payer: BCN Medicare Advantage |
$104.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.09
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.27
|
| Rate for Payer: Mclaren Medicaid |
$73.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.29
|
| Rate for Payer: Meridian Medicaid |
$77.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Senior Care Partners |
$98.89
|
| Rate for Payer: PACE SWMI |
$104.09
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: PHP Medicare Advantage |
$104.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.23
|
| Rate for Payer: Priority Health Medicare |
$105.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.79
|
| Rate for Payer: Railroad Medicare Medicare |
$104.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.40
|
| Rate for Payer: UHC Core |
$347.66
|
| Rate for Payer: UHC Exchange |
$104.09
|
| Rate for Payer: UHC Medicaid |
$73.40
|
| Rate for Payer: UHC Medicare Advantage |
$104.09
|
| Rate for Payer: UHCCP Medicaid |
$73.40
|
| Rate for Payer: VA VA |
$104.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.27
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$270.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.38
|
| Rate for Payer: BCBS Complete |
$192.73
|
| Rate for Payer: BCBS MAPPO |
$260.30
|
| Rate for Payer: BCBS Trust/PPO |
$855.97
|
| Rate for Payer: BCN Commercial |
$855.97
|
| Rate for Payer: BCN Medicare Advantage |
$260.30
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.30
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Mclaren Medicaid |
$183.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.31
|
| Rate for Payer: Meridian Medicaid |
$192.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Senior Care Partners |
$247.28
|
| Rate for Payer: PACE SWMI |
$260.30
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: PHP Medicare Advantage |
$260.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Medicare |
$262.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: Railroad Medicare Medicare |
$260.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: UHC Exchange |
$260.30
|
| Rate for Payer: UHC Medicaid |
$183.56
|
| Rate for Payer: UHC Medicare Advantage |
$260.30
|
| Rate for Payer: UHCCP Medicaid |
$183.56
|
| Rate for Payer: VA VA |
$260.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$724.68 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: BCBS Trust/PPO |
$859.93
|
| Rate for Payer: BCN Commercial |
$859.93
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$941.92 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.72
|
| Rate for Payer: BCN Commercial |
$1,117.72
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.59 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$351.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.92
|
| Rate for Payer: BCBS Complete |
$250.50
|
| Rate for Payer: BCBS MAPPO |
$338.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.58
|
| Rate for Payer: BCN Commercial |
$1,112.58
|
| Rate for Payer: BCN Medicare Advantage |
$338.33
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.33
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Mclaren Medicaid |
$238.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.25
|
| Rate for Payer: Meridian Medicaid |
$250.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$372.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PACE Senior Care Partners |
$321.42
|
| Rate for Payer: PACE SWMI |
$338.33
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$338.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Medicare |
$341.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.92
|
| Rate for Payer: Railroad Medicare Medicare |
$338.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: UHC Exchange |
$338.33
|
| Rate for Payer: UHC Medicaid |
$238.59
|
| Rate for Payer: UHC Medicare Advantage |
$338.33
|
| Rate for Payer: UHCCP Medicaid |
$238.59
|
| Rate for Payer: VA VA |
$338.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC XR RIBS 2 VW
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.71 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: BCBS Trust/PPO |
$301.07
|
| Rate for Payer: BCN Commercial |
$301.07
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC XR RIBS 2 VW
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.92
|
| Rate for Payer: BCBS Complete |
$67.47
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.68
|
| Rate for Payer: BCN Commercial |
$299.68
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: Meridian Medicaid |
$67.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Senior Care Partners |
$86.58
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Medicare |
$92.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: UHC Exchange |
$91.13
|
| Rate for Payer: UHC Medicaid |
$64.27
|
| Rate for Payer: UHC Medicare Advantage |
$91.13
|
| Rate for Payer: UHCCP Medicaid |
$64.27
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
IP
|
$468.74
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.24 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: BCBS Trust/PPO |
$387.13
|
| Rate for Payer: BCN Commercial |
$387.13
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.49
|
| Rate for Payer: UHC Core |
$391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.56
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
OP
|
$468.74
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna Medicare |
$121.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.48
|
| Rate for Payer: BCBS Complete |
$86.76
|
| Rate for Payer: BCBS MAPPO |
$117.19
|
| Rate for Payer: BCBS Trust/PPO |
$385.35
|
| Rate for Payer: BCN Commercial |
$385.35
|
| Rate for Payer: BCN Medicare Advantage |
$117.19
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.19
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.56
|
| Rate for Payer: Mclaren Medicaid |
$82.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.04
|
| Rate for Payer: Meridian Medicaid |
$86.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PACE Senior Care Partners |
$111.33
|
| Rate for Payer: PACE SWMI |
$117.19
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: PHP Medicare Advantage |
$117.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.80
|
| Rate for Payer: Priority Health Medicare |
$118.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.24
|
| Rate for Payer: Railroad Medicare Medicare |
$117.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.49
|
| Rate for Payer: UHC Core |
$391.40
|
| Rate for Payer: UHC Exchange |
$117.19
|
| Rate for Payer: UHC Medicaid |
$82.64
|
| Rate for Payer: UHC Medicare Advantage |
$117.19
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
| Rate for Payer: VA VA |
$117.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.56
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
OP
|
$468.74
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna Medicare |
$121.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.48
|
| Rate for Payer: BCBS Complete |
$86.76
|
| Rate for Payer: BCBS MAPPO |
$117.19
|
| Rate for Payer: BCBS Trust/PPO |
$385.35
|
| Rate for Payer: BCN Commercial |
$385.35
|
| Rate for Payer: BCN Medicare Advantage |
$117.19
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.19
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.56
|
| Rate for Payer: Mclaren Medicaid |
$82.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.04
|
| Rate for Payer: Meridian Medicaid |
$86.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PACE Senior Care Partners |
$111.33
|
| Rate for Payer: PACE SWMI |
$117.19
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: PHP Medicare Advantage |
$117.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.80
|
| Rate for Payer: Priority Health Medicare |
$118.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.24
|
| Rate for Payer: Railroad Medicare Medicare |
$117.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.49
|
| Rate for Payer: UHC Core |
$391.40
|
| Rate for Payer: UHC Exchange |
$117.19
|
| Rate for Payer: UHC Medicaid |
$82.64
|
| Rate for Payer: UHC Medicare Advantage |
$117.19
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
| Rate for Payer: VA VA |
$117.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.56
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
IP
|
$468.74
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.24 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: BCBS Trust/PPO |
$387.13
|
| Rate for Payer: BCN Commercial |
$387.13
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.49
|
| Rate for Payer: UHC Core |
$391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.56
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.79 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Aetna Commercial |
$353.91
|
| Rate for Payer: BCBS Trust/PPO |
$343.87
|
| Rate for Payer: BCN Commercial |
$343.87
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$358.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$374.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PHP Commercial |
$353.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.40
|
| Rate for Payer: UHC Core |
$347.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.27
|
|
