|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$135.98
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.39 |
| Max. Negotiated Rate |
$122.38 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: BCBS Trust/PPO |
$111.00
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Healthscope Commercial |
$122.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.58
|
| Rate for Payer: Nomi Health Commercial |
$111.50
|
| Rate for Payer: PHP Commercial |
$115.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.39
|
| Rate for Payer: Priority Health HMO/PPO |
$118.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.66
|
| Rate for Payer: UHC Core |
$113.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.98
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,224.73
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$1,102.26 |
| Rate for Payer: Aetna Commercial |
$1,041.02
|
| Rate for Payer: Aetna Medicare |
$318.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.73
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$306.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.85
|
| Rate for Payer: BCN Commercial |
$952.23
|
| Rate for Payer: BCN Medicare Advantage |
$306.18
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cofinity Commercial |
$1,053.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.18
|
| Rate for Payer: Healthscope Commercial |
$1,102.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$918.55
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.49
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.02
|
| Rate for Payer: Nomi Health Commercial |
$1,004.28
|
| Rate for Payer: PACE Senior Care Partners |
$290.87
|
| Rate for Payer: PACE SWMI |
$306.18
|
| Rate for Payer: PHP Commercial |
$1,041.02
|
| Rate for Payer: PHP Medicare Advantage |
$306.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,065.52
|
| Rate for Payer: Priority Health Medicare |
$309.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$820.57
|
| Rate for Payer: Railroad Medicare Medicare |
$306.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.76
|
| Rate for Payer: UHC Core |
$1,022.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.18
|
| Rate for Payer: UHC Exchange |
$306.18
|
| Rate for Payer: UHC Medicare Advantage |
$306.18
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$306.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$918.55
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,224.73
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$796.07 |
| Max. Negotiated Rate |
$1,102.26 |
| Rate for Payer: Aetna Commercial |
$1,041.02
|
| Rate for Payer: BCBS Trust/PPO |
$999.75
|
| Rate for Payer: BCN Commercial |
$946.47
|
| Rate for Payer: Cash Price |
$979.78
|
| Rate for Payer: Cofinity Commercial |
$1,053.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.78
|
| Rate for Payer: Healthscope Commercial |
$1,102.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$918.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.02
|
| Rate for Payer: Nomi Health Commercial |
$1,004.28
|
| Rate for Payer: PHP Commercial |
$1,041.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,065.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$820.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.76
|
| Rate for Payer: UHC Core |
$1,022.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$918.55
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$272.22
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$231.39
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.07
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$68.06
|
| Rate for Payer: BCBS Trust/PPO |
$223.79
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: BCN Medicare Advantage |
$68.06
|
| Rate for Payer: Cash Price |
$217.78
|
| Rate for Payer: Cash Price |
$217.78
|
| Rate for Payer: Cofinity Commercial |
$234.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.06
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.16
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.46
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.39
|
| Rate for Payer: Nomi Health Commercial |
$223.22
|
| Rate for Payer: PACE Senior Care Partners |
$64.65
|
| Rate for Payer: PACE SWMI |
$68.06
|
| Rate for Payer: PHP Commercial |
$231.39
|
| Rate for Payer: PHP Medicare Advantage |
$68.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.94
|
| Rate for Payer: Priority Health HMO/PPO |
$236.83
|
| Rate for Payer: Priority Health Medicare |
$68.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.39
|
| Rate for Payer: Railroad Medicare Medicare |
$68.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.55
|
| Rate for Payer: UHC Core |
$227.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.06
|
| Rate for Payer: UHC Exchange |
$68.06
|
| Rate for Payer: UHC Medicare Advantage |
$68.06
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$68.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.16
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$272.22
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.94 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$231.39
|
| Rate for Payer: BCBS Trust/PPO |
$222.21
|
| Rate for Payer: BCN Commercial |
$210.37
|
| Rate for Payer: Cash Price |
$217.78
|
| Rate for Payer: Cofinity Commercial |
$234.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.78
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.39
|
| Rate for Payer: Nomi Health Commercial |
$223.22
|
| Rate for Payer: PHP Commercial |
$231.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.94
|
| Rate for Payer: Priority Health HMO/PPO |
$236.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.55
|
| Rate for Payer: UHC Core |
$227.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.16
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$346.92
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
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 ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$346.92
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.33 |
| 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 |
$79.10
|
| 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 |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.07
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| 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 |
$75.33
|
| 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 |
$75.33
|
| Rate for Payer: VA VA |
$86.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.19
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$88.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.36
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$85.08
|
| Rate for Payer: BCBS Trust/PPO |
$279.79
|
| Rate for Payer: BCN Commercial |
$264.61
|
| Rate for Payer: BCN Medicare Advantage |
$85.08
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.08
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.26
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.34
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PACE Senior Care Partners |
$80.83
|
| Rate for Payer: PACE SWMI |
$85.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: PHP Medicare Advantage |
$85.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Medicare |
$85.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: Railroad Medicare Medicare |
$85.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.08
|
| Rate for Payer: UHC Exchange |
$85.08
|
| Rate for Payer: UHC Medicare Advantage |
$85.08
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$85.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.26
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.22 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: BCBS Trust/PPO |
$277.82
|
| Rate for Payer: BCN Commercial |
$263.01
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.26
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$306.43
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: BCBS Trust/PPO |
$250.14
|
| Rate for Payer: BCN Commercial |
$236.81
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: Nomi Health Commercial |
$251.27
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health HMO/PPO |
$266.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.66
|
| Rate for Payer: UHC Core |
$255.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$306.43
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna Medicare |
$79.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.76
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$76.61
|
| Rate for Payer: BCBS Trust/PPO |
$251.92
|
| Rate for Payer: BCN Commercial |
$238.25
|
| Rate for Payer: BCN Medicare Advantage |
$76.61
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.82
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.44
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: Nomi Health Commercial |
$251.27
|
| Rate for Payer: PACE Senior Care Partners |
$72.78
|
| Rate for Payer: PACE SWMI |
$76.61
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: PHP Medicare Advantage |
$76.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health HMO/PPO |
$266.59
|
| Rate for Payer: Priority Health Medicare |
$77.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.31
|
| Rate for Payer: Railroad Medicare Medicare |
$76.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.66
|
| Rate for Payer: UHC Core |
$255.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.61
|
| Rate for Payer: UHC Exchange |
$76.61
|
| Rate for Payer: UHC Medicare Advantage |
$76.61
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$76.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$296.34
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.62 |
| Max. Negotiated Rate |
$266.71 |
| Rate for Payer: Aetna Commercial |
$251.89
|
| Rate for Payer: BCBS Trust/PPO |
$241.90
|
| Rate for Payer: BCN Commercial |
$229.01
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cofinity Commercial |
$254.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.07
|
| Rate for Payer: Healthscope Commercial |
$266.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.89
|
| Rate for Payer: Nomi Health Commercial |
$243.00
|
| Rate for Payer: PHP Commercial |
$251.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.62
|
| Rate for Payer: Priority Health HMO/PPO |
$257.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.78
|
| Rate for Payer: UHC Core |
$247.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.26
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$296.34
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$266.71 |
| Rate for Payer: Aetna Commercial |
$251.89
|
| Rate for Payer: Aetna Medicare |
$77.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.61
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$74.08
|
| Rate for Payer: BCBS Trust/PPO |
$243.62
|
| Rate for Payer: BCN Commercial |
$230.40
|
| Rate for Payer: BCN Medicare Advantage |
$74.08
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cofinity Commercial |
$254.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$266.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.26
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.79
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.89
|
| Rate for Payer: Nomi Health Commercial |
$243.00
|
| Rate for Payer: PACE Senior Care Partners |
$70.38
|
| Rate for Payer: PACE SWMI |
$74.08
|
| Rate for Payer: PHP Commercial |
$251.89
|
| Rate for Payer: PHP Medicare Advantage |
$74.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.62
|
| Rate for Payer: Priority Health HMO/PPO |
$257.82
|
| Rate for Payer: Priority Health Medicare |
$74.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.55
|
| Rate for Payer: Railroad Medicare Medicare |
$74.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.78
|
| Rate for Payer: UHC Core |
$247.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.08
|
| Rate for Payer: UHC Exchange |
$74.08
|
| Rate for Payer: UHC Medicare Advantage |
$74.08
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$74.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.26
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: BCBS Trust/PPO |
$333.21
|
| Rate for Payer: BCN Commercial |
$315.46
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO |
$355.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.22
|
| Rate for Payer: UHC Core |
$340.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$106.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.56
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$102.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.58
|
| Rate for Payer: BCN Commercial |
$317.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.05
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.05
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Senior Care Partners |
$96.95
|
| Rate for Payer: PACE SWMI |
$102.05
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$102.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO |
$355.13
|
| Rate for Payer: Priority Health Medicare |
$103.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.49
|
| Rate for Payer: Railroad Medicare Medicare |
$102.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.22
|
| Rate for Payer: UHC Core |
$340.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.05
|
| Rate for Payer: UHC Exchange |
$102.05
|
| Rate for Payer: UHC Medicare Advantage |
$102.05
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$102.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$255.20
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.20
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.20
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.58
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.20
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.20
|
| Rate for Payer: UHC Exchange |
$255.20
|
| Rate for Payer: UHC Medicare Advantage |
$255.20
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$255.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.58
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.58
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$862.42 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.07
|
| Rate for Payer: BCN Commercial |
$1,025.35
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.98 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$344.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$414.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$414.62
|
| Rate for Payer: BCBS Complete |
$265.65
|
| Rate for Payer: BCBS MAPPO |
$331.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.76
|
| Rate for Payer: BCN Commercial |
$1,031.59
|
| Rate for Payer: BCN Medicare Advantage |
$331.70
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.70
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Mclaren Medicaid |
$252.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$348.28
|
| Rate for Payer: Meridian Medicaid |
$265.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: PACE Senior Care Partners |
$315.12
|
| Rate for Payer: PACE SWMI |
$331.70
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: PHP Medicare Advantage |
$331.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.32
|
| Rate for Payer: Priority Health Medicare |
$335.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.96
|
| Rate for Payer: Railroad Medicare Medicare |
$331.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.70
|
| Rate for Payer: UHC Exchange |
$331.70
|
| Rate for Payer: UHC Medicare Advantage |
$331.70
|
| Rate for Payer: UHCCP Medicaid |
$252.98
|
| Rate for Payer: VA VA |
$331.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC XR RIBS 2 VW
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$92.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.68
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$89.34
|
| Rate for Payer: BCBS Trust/PPO |
$293.80
|
| Rate for Payer: BCN Commercial |
$277.86
|
| Rate for Payer: BCN Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.34
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Senior Care Partners |
$84.88
|
| Rate for Payer: PACE SWMI |
$89.34
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Medicare |
$90.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: Railroad Medicare Medicare |
$89.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.34
|
| Rate for Payer: UHC Exchange |
$89.34
|
| Rate for Payer: UHC Medicare Advantage |
$89.34
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC XR RIBS 2 VW
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: BCBS Trust/PPO |
$291.73
|
| Rate for Payer: BCN Commercial |
$276.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
IP
|
$459.55
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.71 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: BCBS Trust/PPO |
$375.13
|
| Rate for Payer: BCN Commercial |
$355.14
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$119.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.61
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$114.89
|
| Rate for Payer: BCBS Trust/PPO |
$377.80
|
| Rate for Payer: BCN Commercial |
$357.30
|
| Rate for Payer: BCN Medicare Advantage |
$114.89
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.89
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.63
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PACE Senior Care Partners |
$109.14
|
| Rate for Payer: PACE SWMI |
$114.89
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$114.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Medicare |
$116.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: Railroad Medicare Medicare |
$114.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.89
|
| Rate for Payer: UHC Exchange |
$114.89
|
| Rate for Payer: UHC Medicare Advantage |
$114.89
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$114.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$119.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.61
|
| Rate for Payer: BCBS Complete |
$79.10
|
| Rate for Payer: BCBS MAPPO |
$114.89
|
| Rate for Payer: BCBS Trust/PPO |
$377.80
|
| Rate for Payer: BCN Commercial |
$357.30
|
| Rate for Payer: BCN Medicare Advantage |
$114.89
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.89
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Mclaren Medicaid |
$75.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.63
|
| Rate for Payer: Meridian Medicaid |
$79.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PACE Senior Care Partners |
$109.14
|
| Rate for Payer: PACE SWMI |
$114.89
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$114.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Medicare |
$116.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: Railroad Medicare Medicare |
$114.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.89
|
| Rate for Payer: UHC Exchange |
$114.89
|
| Rate for Payer: UHC Medicare Advantage |
$114.89
|
| Rate for Payer: UHCCP Medicaid |
$75.33
|
| Rate for Payer: VA VA |
$114.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
IP
|
$459.55
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.71 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: BCBS Trust/PPO |
$375.13
|
| Rate for Payer: BCN Commercial |
$355.14
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
