|
HC XR ESOPHAGEAL DILATION
|
Facility
|
OP
|
$263.05
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$236.75 |
| Rate for Payer: Aetna Commercial |
$223.59
|
| Rate for Payer: Aetna Medicare |
$68.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.20
|
| Rate for Payer: BCBS Complete |
$105.22
|
| Rate for Payer: BCBS MAPPO |
$65.76
|
| Rate for Payer: BCBS Trust/PPO |
$216.25
|
| Rate for Payer: BCN Commercial |
$204.52
|
| Rate for Payer: BCN Medicare Advantage |
$65.76
|
| Rate for Payer: Cash Price |
$210.44
|
| Rate for Payer: Cofinity Commercial |
$226.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.76
|
| Rate for Payer: Healthscope Commercial |
$236.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.59
|
| Rate for Payer: Nomi Health Commercial |
$215.70
|
| Rate for Payer: PACE Senior Care Partners |
$62.47
|
| Rate for Payer: PACE SWMI |
$65.76
|
| Rate for Payer: PHP Commercial |
$223.59
|
| Rate for Payer: PHP Medicare Advantage |
$65.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health HMO/PPO |
$228.85
|
| Rate for Payer: Priority Health Medicare |
$66.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.24
|
| Rate for Payer: Railroad Medicare Medicare |
$65.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.76
|
| Rate for Payer: UHC Exchange |
$65.76
|
| Rate for Payer: UHC Medicare Advantage |
$65.76
|
| Rate for Payer: VA VA |
$65.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.29
|
|
|
HC XR ESOPHAGEAL DILATION
|
Facility
|
IP
|
$263.05
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.98 |
| Max. Negotiated Rate |
$236.75 |
| Rate for Payer: Aetna Commercial |
$223.59
|
| Rate for Payer: BCBS Trust/PPO |
$214.73
|
| Rate for Payer: BCN Commercial |
$203.29
|
| Rate for Payer: Cash Price |
$210.44
|
| Rate for Payer: Cofinity Commercial |
$226.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.44
|
| Rate for Payer: Healthscope Commercial |
$236.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.59
|
| Rate for Payer: Nomi Health Commercial |
$215.70
|
| Rate for Payer: PHP Commercial |
$223.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.98
|
| Rate for Payer: Priority Health HMO/PPO |
$228.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.48
|
| Rate for Payer: UHC Core |
$219.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.29
|
|
|
HC XR ESOPHAGUS
|
Facility
|
OP
|
$642.88
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna Medicare |
$167.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.90
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$160.72
|
| Rate for Payer: BCBS Trust/PPO |
$528.51
|
| Rate for Payer: BCN Commercial |
$499.84
|
| Rate for Payer: BCN Medicare Advantage |
$160.72
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.72
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.16
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.76
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| Rate for Payer: PACE Senior Care Partners |
$152.68
|
| Rate for Payer: PACE SWMI |
$160.72
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: PHP Medicare Advantage |
$160.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health HMO/PPO |
$559.31
|
| Rate for Payer: Priority Health Medicare |
$162.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.73
|
| Rate for Payer: Railroad Medicare Medicare |
$160.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.73
|
| Rate for Payer: UHC Core |
$536.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.72
|
| Rate for Payer: UHC Exchange |
$160.72
|
| Rate for Payer: UHC Medicare Advantage |
$160.72
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$160.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.16
|
|
|
HC XR ESOPHAGUS
|
Facility
|
IP
|
$642.88
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
32000136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.87 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: BCBS Trust/PPO |
$524.78
|
| Rate for Payer: BCN Commercial |
$496.82
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health HMO/PPO |
$559.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.73
|
| Rate for Payer: UHC Core |
$536.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.16
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna Medicare |
$127.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.44
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$122.75
|
| Rate for Payer: BCBS Trust/PPO |
$403.65
|
| Rate for Payer: BCN Commercial |
$381.75
|
| Rate for Payer: BCN Medicare Advantage |
$122.75
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.75
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.35
|
| Rate for Payer: Nomi Health Commercial |
$402.62
|
| Rate for Payer: PACE Senior Care Partners |
$116.61
|
| Rate for Payer: PACE SWMI |
$122.75
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: PHP Medicare Advantage |
$122.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health HMO/PPO |
$427.17
|
| Rate for Payer: Priority Health Medicare |
$123.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.97
|
| Rate for Payer: Railroad Medicare Medicare |
$122.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.08
|
| Rate for Payer: UHC Core |
$409.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.75
|
| Rate for Payer: UHC Exchange |
$122.75
|
| Rate for Payer: UHC Medicare Advantage |
$122.75
|
| Rate for Payer: VA VA |
$122.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.25
|
|
|
HC XR ESOPHAGUS FB
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 74235
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.15 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: BCBS Trust/PPO |
$400.80
|
| Rate for Payer: BCN Commercial |
$379.44
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.35
|
| Rate for Payer: Nomi Health Commercial |
$402.62
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health HMO/PPO |
$427.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.08
|
| Rate for Payer: UHC Core |
$409.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.25
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
IP
|
$642.88
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.87 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: BCBS Trust/PPO |
$524.78
|
| Rate for Payer: BCN Commercial |
$496.82
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health HMO/PPO |
$559.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.73
|
| Rate for Payer: UHC Core |
$536.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.16
|
|
|
HC XR ESOPHAGUS HIGH DENSITY
|
Facility
|
OP
|
$642.88
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
32000330
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$578.59 |
| Rate for Payer: Aetna Commercial |
$546.45
|
| Rate for Payer: Aetna Medicare |
$167.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.90
|
| Rate for Payer: BCBS Complete |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$160.72
|
| Rate for Payer: BCBS Trust/PPO |
$528.51
|
| Rate for Payer: BCN Commercial |
$499.84
|
| Rate for Payer: BCN Medicare Advantage |
$160.72
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cash Price |
$514.30
|
| Rate for Payer: Cofinity Commercial |
$552.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.72
|
| Rate for Payer: Healthscope Commercial |
$578.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.16
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.76
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.45
|
| Rate for Payer: Nomi Health Commercial |
$527.16
|
| Rate for Payer: PACE Senior Care Partners |
$152.68
|
| Rate for Payer: PACE SWMI |
$160.72
|
| Rate for Payer: PHP Commercial |
$546.45
|
| Rate for Payer: PHP Medicare Advantage |
$160.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.87
|
| Rate for Payer: Priority Health HMO/PPO |
$559.31
|
| Rate for Payer: Priority Health Medicare |
$162.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.73
|
| Rate for Payer: Railroad Medicare Medicare |
$160.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.73
|
| Rate for Payer: UHC Core |
$536.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.72
|
| Rate for Payer: UHC Exchange |
$160.72
|
| Rate for Payer: UHC Medicare Advantage |
$160.72
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$160.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.16
|
|
|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
OP
|
$459.68
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$413.71 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: Aetna Medicare |
$119.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.65
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$114.92
|
| Rate for Payer: BCBS Trust/PPO |
$377.90
|
| Rate for Payer: BCN Commercial |
$357.40
|
| Rate for Payer: BCN Medicare Advantage |
$114.92
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$395.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.92
|
| Rate for Payer: Healthscope Commercial |
$413.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.76
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.67
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.73
|
| Rate for Payer: Nomi Health Commercial |
$376.94
|
| Rate for Payer: PACE Senior Care Partners |
$109.17
|
| Rate for Payer: PACE SWMI |
$114.92
|
| Rate for Payer: PHP Commercial |
$390.73
|
| Rate for Payer: PHP Medicare Advantage |
$114.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.79
|
| Rate for Payer: Priority Health HMO/PPO |
$399.92
|
| Rate for Payer: Priority Health Medicare |
$116.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.99
|
| Rate for Payer: Railroad Medicare Medicare |
$114.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.52
|
| Rate for Payer: UHC Core |
$383.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.92
|
| Rate for Payer: UHC Exchange |
$114.92
|
| Rate for Payer: UHC Medicare Advantage |
$114.92
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$114.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.76
|
|
|
HC XR EYE FOREIGN BODY PRE MRI
|
Facility
|
IP
|
$459.68
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.79 |
| Max. Negotiated Rate |
$413.71 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: BCBS Trust/PPO |
$375.24
|
| Rate for Payer: BCN Commercial |
$355.24
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$395.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.74
|
| Rate for Payer: Healthscope Commercial |
$413.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.73
|
| Rate for Payer: Nomi Health Commercial |
$376.94
|
| Rate for Payer: PHP Commercial |
$390.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.79
|
| Rate for Payer: Priority Health HMO/PPO |
$399.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.52
|
| Rate for Payer: UHC Core |
$383.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.76
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$459.68
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.79 |
| Max. Negotiated Rate |
$413.71 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: BCBS Trust/PPO |
$375.24
|
| Rate for Payer: BCN Commercial |
$355.24
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$395.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.74
|
| Rate for Payer: Healthscope Commercial |
$413.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.73
|
| Rate for Payer: Nomi Health Commercial |
$376.94
|
| Rate for Payer: PHP Commercial |
$390.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.79
|
| Rate for Payer: Priority Health HMO/PPO |
$399.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.52
|
| Rate for Payer: UHC Core |
$383.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.76
|
|
|
HC XR EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$459.68
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
32000004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$413.71 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: Aetna Medicare |
$119.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.65
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$114.92
|
| Rate for Payer: BCBS Trust/PPO |
$377.90
|
| Rate for Payer: BCN Commercial |
$357.40
|
| Rate for Payer: BCN Medicare Advantage |
$114.92
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cash Price |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$395.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.92
|
| Rate for Payer: Healthscope Commercial |
$413.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.76
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.67
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.73
|
| Rate for Payer: Nomi Health Commercial |
$376.94
|
| Rate for Payer: PACE Senior Care Partners |
$109.17
|
| Rate for Payer: PACE SWMI |
$114.92
|
| Rate for Payer: PHP Commercial |
$390.73
|
| Rate for Payer: PHP Medicare Advantage |
$114.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.79
|
| Rate for Payer: Priority Health HMO/PPO |
$399.92
|
| Rate for Payer: Priority Health Medicare |
$116.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.99
|
| Rate for Payer: Railroad Medicare Medicare |
$114.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.52
|
| Rate for Payer: UHC Core |
$383.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.92
|
| Rate for Payer: UHC Exchange |
$114.92
|
| Rate for Payer: UHC Medicare Advantage |
$114.92
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$114.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.76
|
|
|
HC XR FACIAL BONES MIN 3 VW
|
Facility
|
OP
|
$346.92
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$312.23 |
| Rate for Payer: Aetna Commercial |
$294.88
|
| Rate for Payer: Aetna Medicare |
$90.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.41
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$86.73
|
| Rate for Payer: BCBS Trust/PPO |
$285.20
|
| Rate for Payer: BCN Commercial |
$269.73
|
| Rate for Payer: BCN Medicare Advantage |
$86.73
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$298.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.73
|
| Rate for Payer: Healthscope Commercial |
$312.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.19
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.07
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.88
|
| Rate for Payer: Nomi Health Commercial |
$284.47
|
| Rate for Payer: PACE Senior Care Partners |
$82.39
|
| Rate for Payer: PACE SWMI |
$86.73
|
| Rate for Payer: PHP Commercial |
$294.88
|
| Rate for Payer: PHP Medicare Advantage |
$86.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.50
|
| Rate for Payer: Priority Health HMO/PPO |
$301.82
|
| Rate for Payer: Priority Health Medicare |
$87.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.44
|
| Rate for Payer: Railroad Medicare Medicare |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.29
|
| Rate for Payer: UHC Core |
$289.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.73
|
| Rate for Payer: UHC Exchange |
$86.73
|
| Rate for Payer: UHC Medicare Advantage |
$86.73
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$86.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.19
|
|
|
HC XR FACIAL BONES MIN 3 VW
|
Facility
|
IP
|
$346.92
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$312.23 |
| Rate for Payer: Aetna Commercial |
$294.88
|
| Rate for Payer: BCBS Trust/PPO |
$283.19
|
| Rate for Payer: BCN Commercial |
$268.10
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$298.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.54
|
| Rate for Payer: Healthscope Commercial |
$312.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.88
|
| Rate for Payer: Nomi Health Commercial |
$284.47
|
| Rate for Payer: PHP Commercial |
$294.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.50
|
| Rate for Payer: Priority Health HMO/PPO |
$301.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.29
|
| Rate for Payer: UHC Core |
$289.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.19
|
|
|
HC XR FEMUR 1 VIEW BILATERAL
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC XR FEMUR 1 VIEW BILATERAL
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000341
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC XR FEMUR 2 VIEWS BILATERAL
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000336
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$201.47 |
| Rate for Payer: Aetna Commercial |
$190.27
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.95
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$55.96
|
| Rate for Payer: BCBS Trust/PPO |
$184.03
|
| Rate for Payer: BCN Commercial |
$174.04
|
| Rate for Payer: BCN Medicare Advantage |
$55.96
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cofinity Commercial |
$192.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.96
|
| Rate for Payer: Healthscope Commercial |
$201.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.89
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.76
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: PACE Senior Care Partners |
$53.16
|
| Rate for Payer: PACE SWMI |
$55.96
|
| Rate for Payer: PHP Commercial |
$190.27
|
| Rate for Payer: PHP Medicare Advantage |
$55.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health HMO/PPO |
$194.75
|
| Rate for Payer: Priority Health Medicare |
$56.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.98
|
| Rate for Payer: Railroad Medicare Medicare |
$55.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.99
|
| Rate for Payer: UHC Core |
$186.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.96
|
| Rate for Payer: UHC Exchange |
$55.96
|
| Rate for Payer: UHC Medicare Advantage |
$55.96
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$55.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.89
|
|
|
HC XR FINGERS BIL MIN 2 VW
|
Facility
|
IP
|
$223.85
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$201.47 |
| Rate for Payer: Aetna Commercial |
$190.27
|
| Rate for Payer: BCBS Trust/PPO |
$182.73
|
| Rate for Payer: BCN Commercial |
$172.99
|
| Rate for Payer: Cash Price |
$179.08
|
| Rate for Payer: Cofinity Commercial |
$192.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.08
|
| Rate for Payer: Healthscope Commercial |
$201.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.27
|
| Rate for Payer: Nomi Health Commercial |
$183.56
|
| Rate for Payer: PHP Commercial |
$190.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.50
|
| Rate for Payer: Priority Health HMO/PPO |
$194.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.99
|
| Rate for Payer: UHC Core |
$186.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.89
|
|
|
HC XR FINGERS MIN 2 VW
|
Facility
|
OP
|
$194.04
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$174.64 |
| Rate for Payer: Aetna Commercial |
$164.93
|
| Rate for Payer: Aetna Medicare |
$50.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.64
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$48.51
|
| Rate for Payer: BCBS Trust/PPO |
$159.52
|
| Rate for Payer: BCN Commercial |
$150.87
|
| Rate for Payer: BCN Medicare Advantage |
$48.51
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cofinity Commercial |
$166.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.51
|
| Rate for Payer: Healthscope Commercial |
$174.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.53
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.94
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.93
|
| Rate for Payer: Nomi Health Commercial |
$159.11
|
| Rate for Payer: PACE Senior Care Partners |
$46.08
|
| Rate for Payer: PACE SWMI |
$48.51
|
| Rate for Payer: PHP Commercial |
$164.93
|
| Rate for Payer: PHP Medicare Advantage |
$48.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.13
|
| Rate for Payer: Priority Health HMO/PPO |
$168.81
|
| Rate for Payer: Priority Health Medicare |
$49.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.01
|
| Rate for Payer: Railroad Medicare Medicare |
$48.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.76
|
| Rate for Payer: UHC Core |
$162.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.51
|
| Rate for Payer: UHC Exchange |
$48.51
|
| Rate for Payer: UHC Medicare Advantage |
$48.51
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.53
|
|
|
HC XR FINGERS MIN 2 VW
|
Facility
|
IP
|
$194.04
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
32000089
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$174.64 |
| Rate for Payer: Aetna Commercial |
$164.93
|
| Rate for Payer: BCBS Trust/PPO |
$158.39
|
| Rate for Payer: BCN Commercial |
$149.95
|
| Rate for Payer: Cash Price |
$155.23
|
| Rate for Payer: Cofinity Commercial |
$166.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.23
|
| Rate for Payer: Healthscope Commercial |
$174.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.93
|
| Rate for Payer: Nomi Health Commercial |
$159.11
|
| Rate for Payer: PHP Commercial |
$164.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.13
|
| Rate for Payer: Priority Health HMO/PPO |
$168.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.76
|
| Rate for Payer: UHC Core |
$162.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.53
|
|
|
HC XR FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$313.20
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
32000246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$281.88 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| Rate for Payer: BCBS Trust/PPO |
$255.67
|
| Rate for Payer: BCN Commercial |
$242.04
|
| Rate for Payer: Cash Price |
$250.56
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.56
|
| Rate for Payer: Healthscope Commercial |
$281.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.22
|
| Rate for Payer: Nomi Health Commercial |
$256.82
|
| Rate for Payer: PHP Commercial |
$266.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.58
|
| Rate for Payer: Priority Health HMO/PPO |
$272.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.62
|
| Rate for Payer: UHC Core |
$261.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.90
|
|
|
HC XR FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$313.20
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
32000246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$281.88 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| Rate for Payer: Aetna Medicare |
$81.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.88
|
| Rate for Payer: BCBS Complete |
$125.28
|
| Rate for Payer: BCBS MAPPO |
$78.30
|
| Rate for Payer: BCBS Trust/PPO |
$257.48
|
| Rate for Payer: BCN Commercial |
$243.51
|
| Rate for Payer: BCN Medicare Advantage |
$78.30
|
| Rate for Payer: Cash Price |
$250.56
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.30
|
| Rate for Payer: Healthscope Commercial |
$281.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.22
|
| Rate for Payer: Nomi Health Commercial |
$256.82
|
| Rate for Payer: PACE Senior Care Partners |
$74.39
|
| Rate for Payer: PACE SWMI |
$78.30
|
| Rate for Payer: PHP Commercial |
$266.22
|
| Rate for Payer: PHP Medicare Advantage |
$78.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.58
|
| Rate for Payer: Priority Health HMO/PPO |
$272.48
|
| Rate for Payer: Priority Health Medicare |
$79.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.84
|
| Rate for Payer: Railroad Medicare Medicare |
$78.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.62
|
| Rate for Payer: UHC Core |
$261.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.30
|
| Rate for Payer: UHC Exchange |
$78.30
|
| Rate for Payer: UHC Medicare Advantage |
$78.30
|
| Rate for Payer: VA VA |
$78.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.90
|
|
|
HC XR FOOT 1 VW
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
32000125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
