|
HC XR RIBS INC PA CHST
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
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 SACROILIAC JTS 3 VW OR LESS
|
Facility
|
IP
|
$192.54
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$173.29 |
| Rate for Payer: Aetna Commercial |
$163.66
|
| Rate for Payer: BCBS Trust/PPO |
$159.02
|
| Rate for Payer: BCN Commercial |
$159.02
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.03
|
| Rate for Payer: Healthscope Commercial |
$173.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.66
|
| Rate for Payer: Nomi Health Commercial |
$157.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.41
|
| Rate for Payer: PHP Commercial |
$163.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.44
|
| Rate for Payer: UHC Core |
$160.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.41
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
OP
|
$192.54
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$173.29 |
| Rate for Payer: Aetna Commercial |
$163.66
|
| Rate for Payer: Aetna Medicare |
$50.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.17
|
| Rate for Payer: BCBS Complete |
$35.64
|
| Rate for Payer: BCBS MAPPO |
$48.13
|
| Rate for Payer: BCBS Trust/PPO |
$158.29
|
| Rate for Payer: BCN Commercial |
$158.29
|
| Rate for Payer: BCN Medicare Advantage |
$48.13
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.13
|
| Rate for Payer: Healthscope Commercial |
$173.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.41
|
| Rate for Payer: Mclaren Medicaid |
$33.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.54
|
| Rate for Payer: Meridian Medicaid |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.66
|
| Rate for Payer: Nomi Health Commercial |
$157.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.41
|
| Rate for Payer: PACE Senior Care Partners |
$45.73
|
| Rate for Payer: PACE SWMI |
$48.13
|
| Rate for Payer: PHP Commercial |
$163.66
|
| Rate for Payer: PHP Medicare Advantage |
$48.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.51
|
| Rate for Payer: Priority Health Medicare |
$48.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.01
|
| Rate for Payer: Railroad Medicare Medicare |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.44
|
| Rate for Payer: UHC Core |
$160.77
|
| Rate for Payer: UHC Exchange |
$48.13
|
| Rate for Payer: UHC Medicaid |
$33.94
|
| Rate for Payer: UHC Medicare Advantage |
$48.13
|
| Rate for Payer: UHCCP Medicaid |
$33.94
|
| Rate for Payer: VA VA |
$48.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.41
|
|
|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
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 SACROILIAC JTS 3 VW OR MORE
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
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 SCAPULA
|
Facility
|
OP
|
$374.92
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.10 |
| Max. Negotiated Rate |
$337.43 |
| Rate for Payer: Aetna Commercial |
$318.68
|
| Rate for Payer: Aetna Medicare |
$97.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.16
|
| Rate for Payer: BCBS Complete |
$69.40
|
| Rate for Payer: BCBS MAPPO |
$93.73
|
| Rate for Payer: BCBS Trust/PPO |
$308.22
|
| Rate for Payer: BCN Commercial |
$308.22
|
| Rate for Payer: BCN Medicare Advantage |
$93.73
|
| Rate for Payer: Cash Price |
$299.94
|
| Rate for Payer: Cofinity Commercial |
$322.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.73
|
| Rate for Payer: Healthscope Commercial |
$337.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.19
|
| Rate for Payer: Mclaren Medicaid |
$66.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.42
|
| Rate for Payer: Meridian Medicaid |
$69.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.68
|
| Rate for Payer: Nomi Health Commercial |
$307.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.19
|
| Rate for Payer: PACE Senior Care Partners |
$89.04
|
| Rate for Payer: PACE SWMI |
$93.73
|
| Rate for Payer: PHP Commercial |
$318.68
|
| Rate for Payer: PHP Medicare Advantage |
$93.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.18
|
| Rate for Payer: Priority Health Medicare |
$94.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.94
|
| Rate for Payer: Railroad Medicare Medicare |
$93.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.93
|
| Rate for Payer: UHC Core |
$313.06
|
| Rate for Payer: UHC Exchange |
$93.73
|
| Rate for Payer: UHC Medicaid |
$66.10
|
| Rate for Payer: UHC Medicare Advantage |
$93.73
|
| Rate for Payer: UHCCP Medicaid |
$66.10
|
| Rate for Payer: VA VA |
$93.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.19
|
|
|
HC XR SCAPULA
|
Facility
|
IP
|
$374.92
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.94 |
| Max. Negotiated Rate |
$337.43 |
| Rate for Payer: Aetna Commercial |
$318.68
|
| Rate for Payer: BCBS Trust/PPO |
$309.65
|
| Rate for Payer: BCN Commercial |
$309.65
|
| Rate for Payer: Cash Price |
$299.94
|
| Rate for Payer: Cofinity Commercial |
$322.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.94
|
| Rate for Payer: Healthscope Commercial |
$337.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.68
|
| Rate for Payer: Nomi Health Commercial |
$307.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.19
|
| Rate for Payer: PHP Commercial |
$318.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.93
|
| Rate for Payer: UHC Core |
$313.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.19
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$57.77
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$256.59
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$57.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicaid |
$55.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$55.03
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.24 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$257.78
|
| Rate for Payer: BCN Commercial |
$257.78
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC XR SELLA TURCICA
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
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 SELLA TURCICA
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
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 SHOULDER 1 VW
|
Facility
|
OP
|
$135.42
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Aetna Commercial |
$115.11
|
| Rate for Payer: Aetna Medicare |
$35.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.32
|
| Rate for Payer: BCBS Complete |
$25.07
|
| Rate for Payer: BCBS MAPPO |
$33.85
|
| Rate for Payer: BCBS Trust/PPO |
$111.33
|
| Rate for Payer: BCN Commercial |
$111.33
|
| Rate for Payer: BCN Medicare Advantage |
$33.85
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.85
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.56
|
| Rate for Payer: Mclaren Medicaid |
$23.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$25.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: PACE Senior Care Partners |
$32.16
|
| Rate for Payer: PACE SWMI |
$33.85
|
| Rate for Payer: PHP Commercial |
$115.11
|
| Rate for Payer: PHP Medicare Advantage |
$33.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.82
|
| Rate for Payer: Priority Health Medicare |
$34.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.25
|
| Rate for Payer: Railroad Medicare Medicare |
$33.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.17
|
| Rate for Payer: UHC Core |
$113.08
|
| Rate for Payer: UHC Exchange |
$33.85
|
| Rate for Payer: UHC Medicaid |
$23.87
|
| Rate for Payer: UHC Medicare Advantage |
$33.85
|
| Rate for Payer: UHCCP Medicaid |
$23.87
|
| Rate for Payer: VA VA |
$33.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.56
|
|
|
HC XR SHOULDER 1 VW
|
Facility
|
IP
|
$135.42
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Aetna Commercial |
$115.11
|
| Rate for Payer: BCBS Trust/PPO |
$111.84
|
| Rate for Payer: BCN Commercial |
$111.84
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: PHP Commercial |
$115.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.17
|
| Rate for Payer: UHC Core |
$113.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.56
|
|
|
HC XR SHOULDER 1 VW BILATERAL
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: BCBS Trust/PPO |
$210.52
|
| Rate for Payer: BCN Commercial |
$210.52
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC XR SHOULDER 1 VW BILATERAL
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.66
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$63.73
|
| Rate for Payer: BCBS Trust/PPO |
$209.55
|
| Rate for Payer: BCN Commercial |
$209.55
|
| Rate for Payer: BCN Medicare Advantage |
$63.73
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PACE Senior Care Partners |
$60.54
|
| Rate for Payer: PACE SWMI |
$63.73
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: PHP Medicare Advantage |
$63.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.41
|
| Rate for Payer: Railroad Medicare Medicare |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: UHC Exchange |
$63.73
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHC Medicare Advantage |
$63.73
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: VA VA |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC XR SHOULDER BIL 1 VW
|
Facility
|
OP
|
$178.57
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$160.71 |
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Medicare |
$46.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.80
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS MAPPO |
$44.64
|
| Rate for Payer: BCBS Trust/PPO |
$146.80
|
| Rate for Payer: BCN Commercial |
$146.80
|
| Rate for Payer: BCN Medicare Advantage |
$44.64
|
| Rate for Payer: Cash Price |
$142.86
|
| Rate for Payer: Cofinity Commercial |
$153.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.64
|
| Rate for Payer: Healthscope Commercial |
$160.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.93
|
| Rate for Payer: Mclaren Medicaid |
$31.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.87
|
| Rate for Payer: Meridian Medicaid |
$33.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Nomi Health Commercial |
$146.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.93
|
| Rate for Payer: PACE Senior Care Partners |
$42.41
|
| Rate for Payer: PACE SWMI |
$44.64
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Medicare Advantage |
$44.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.36
|
| Rate for Payer: Priority Health Medicare |
$45.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.28
|
| Rate for Payer: Railroad Medicare Medicare |
$44.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.14
|
| Rate for Payer: UHC Core |
$149.11
|
| Rate for Payer: UHC Exchange |
$44.64
|
| Rate for Payer: UHC Medicaid |
$31.48
|
| Rate for Payer: UHC Medicare Advantage |
$44.64
|
| Rate for Payer: UHCCP Medicaid |
$31.48
|
| Rate for Payer: VA VA |
$44.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.93
|
|
|
HC XR SHOULDER BIL 1 VW
|
Facility
|
IP
|
$178.57
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.28 |
| Max. Negotiated Rate |
$160.71 |
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: BCBS Trust/PPO |
$147.48
|
| Rate for Payer: BCN Commercial |
$147.48
|
| Rate for Payer: Cash Price |
$142.86
|
| Rate for Payer: Cofinity Commercial |
$153.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.86
|
| Rate for Payer: Healthscope Commercial |
$160.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Nomi Health Commercial |
$146.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.93
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.14
|
| Rate for Payer: UHC Core |
$149.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.93
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
OP
|
$460.68
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$414.61 |
| Rate for Payer: Aetna Commercial |
$391.58
|
| Rate for Payer: Aetna Medicare |
$119.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.96
|
| Rate for Payer: BCBS Complete |
$85.27
|
| Rate for Payer: BCBS MAPPO |
$115.17
|
| Rate for Payer: BCBS Trust/PPO |
$378.73
|
| Rate for Payer: BCN Commercial |
$378.73
|
| Rate for Payer: BCN Medicare Advantage |
$115.17
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cofinity Commercial |
$396.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.17
|
| Rate for Payer: Healthscope Commercial |
$414.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.51
|
| Rate for Payer: Mclaren Medicaid |
$81.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.93
|
| Rate for Payer: Meridian Medicaid |
$85.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.58
|
| Rate for Payer: Nomi Health Commercial |
$377.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.51
|
| Rate for Payer: PACE Senior Care Partners |
$109.41
|
| Rate for Payer: PACE SWMI |
$115.17
|
| Rate for Payer: PHP Commercial |
$391.58
|
| Rate for Payer: PHP Medicare Advantage |
$115.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$400.79
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.63
|
| Rate for Payer: Railroad Medicare Medicare |
$115.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.40
|
| Rate for Payer: UHC Core |
$384.67
|
| Rate for Payer: UHC Exchange |
$115.17
|
| Rate for Payer: UHC Medicaid |
$81.22
|
| Rate for Payer: UHC Medicare Advantage |
$115.17
|
| Rate for Payer: UHCCP Medicaid |
$81.22
|
| Rate for Payer: VA VA |
$115.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.51
|
|
|
HC XR SHOULDER BIL MIN 2 VW
|
Facility
|
IP
|
$460.68
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.63 |
| Max. Negotiated Rate |
$414.61 |
| Rate for Payer: Aetna Commercial |
$391.58
|
| Rate for Payer: BCBS Trust/PPO |
$380.48
|
| Rate for Payer: BCN Commercial |
$380.48
|
| Rate for Payer: Cash Price |
$368.54
|
| Rate for Payer: Cofinity Commercial |
$396.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.54
|
| Rate for Payer: Healthscope Commercial |
$414.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.58
|
| Rate for Payer: Nomi Health Commercial |
$377.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.51
|
| Rate for Payer: PHP Commercial |
$391.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$400.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.40
|
| Rate for Payer: UHC Core |
$384.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.51
|
|
|
HC XR SHOULDER MIN 2 VW
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
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 SHOULDER MIN 2 VW
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
32000065
|
|
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 SINUSES LESS THAN 3 VW
|
Facility
|
OP
|
$208.31
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$187.48 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: Aetna Medicare |
$54.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.10
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS MAPPO |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.25
|
| Rate for Payer: BCN Commercial |
$171.25
|
| Rate for Payer: BCN Medicare Advantage |
$52.08
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.23
|
| Rate for Payer: Mclaren Medicaid |
$36.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.68
|
| Rate for Payer: Meridian Medicaid |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PACE Senior Care Partners |
$49.47
|
| Rate for Payer: PACE SWMI |
$52.08
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.23
|
| Rate for Payer: Priority Health Medicare |
$52.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.98
|
| Rate for Payer: Railroad Medicare Medicare |
$52.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.31
|
| Rate for Payer: UHC Core |
$173.94
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Medicaid |
$36.73
|
| Rate for Payer: UHC Medicare Advantage |
$52.08
|
| Rate for Payer: UHCCP Medicaid |
$36.73
|
| Rate for Payer: VA VA |
$52.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.23
|
|
|
HC XR SINUSES LESS THAN 3 VW
|
Facility
|
IP
|
$208.31
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
32000013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$187.48 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: BCBS Trust/PPO |
$172.04
|
| Rate for Payer: BCN Commercial |
$172.04
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.31
|
| Rate for Payer: UHC Core |
$173.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.23
|
|
