|
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 |
$63.66 |
| 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 |
$66.85
|
| 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 |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.44
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| 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 |
$63.66
|
| 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 |
$63.66
|
| Rate for Payer: VA VA |
$76.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
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 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 |
$80.73
|
| 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 |
$222.25
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.79
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$74.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.25
|
|
|
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 |
$222.25
|
| 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 |
$222.25
|
|
|
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 |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$102.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
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 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 |
$765.59
|
| 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 |
$765.59
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.71 |
| 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 |
$135.15
|
| Rate for Payer: BCBS MAPPO |
$255.19
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.19
|
| 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 |
$255.19
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$128.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$135.15
|
| 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 |
$255.19
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.71
|
| 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 |
$255.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.19
|
| Rate for Payer: UHC Exchange |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$255.19
|
| Rate for Payer: UHCCP Medicaid |
$128.71
|
| Rate for Payer: VA VA |
$255.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
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 |
$258.20 |
| 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 |
$271.13
|
| 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 |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$348.29
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.45
|
| 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 |
$258.20
|
| 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 |
$258.20
|
| 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 |
$63.66 |
| 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 |
$66.85
|
| 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 |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| 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 |
$63.66
|
| 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 |
$63.66
|
| 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
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.63
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$114.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
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 MIN 3 VW
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.63
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| 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
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$102.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
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 SACROILIAC JTS 3 VW OR LESS
|
Facility
|
OP
|
$188.76
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.83 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Medicare |
$49.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.99
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$146.76
|
| Rate for Payer: BCN Medicare Advantage |
$47.19
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.19
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.55
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Nomi Health Commercial |
$154.78
|
| Rate for Payer: PACE Senior Care Partners |
$44.83
|
| Rate for Payer: PACE SWMI |
$47.19
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: PHP Medicare Advantage |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.69
|
| Rate for Payer: Priority Health HMO/PPO |
$164.22
|
| Rate for Payer: Priority Health Medicare |
$47.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.47
|
| Rate for Payer: Railroad Medicare Medicare |
$47.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$157.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.19
|
| Rate for Payer: UHC Exchange |
$47.19
|
| Rate for Payer: UHC Medicare Advantage |
$47.19
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$47.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
IP
|
$188.76
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: BCBS Trust/PPO |
$154.08
|
| Rate for Payer: BCN Commercial |
$145.87
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Nomi Health Commercial |
$154.78
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.69
|
| Rate for Payer: Priority Health HMO/PPO |
$164.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$157.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| 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 |
$80.73
|
| 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 |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| 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 |
$76.88
|
| 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 |
$76.88
|
| Rate for Payer: VA VA |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
IP
|
$306.43
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
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 SACRUM COCCYX MIN 2 VW
|
Facility
|
OP
|
$306.43
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.66 |
| 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 |
$66.85
|
| 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 |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.44
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| 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 |
$63.66
|
| 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 |
$63.66
|
| Rate for Payer: VA VA |
$76.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR SCAPULA
|
Facility
|
OP
|
$367.57
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$330.81 |
| Rate for Payer: Aetna Commercial |
$312.43
|
| Rate for Payer: Aetna Medicare |
$95.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.87
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$91.89
|
| Rate for Payer: BCBS Trust/PPO |
$302.18
|
| Rate for Payer: BCN Commercial |
$285.79
|
| Rate for Payer: BCN Medicare Advantage |
$91.89
|
| Rate for Payer: Cash Price |
$294.06
|
| Rate for Payer: Cash Price |
$294.06
|
| Rate for Payer: Cofinity Commercial |
$316.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.89
|
| Rate for Payer: Healthscope Commercial |
$330.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.68
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.49
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.43
|
| Rate for Payer: Nomi Health Commercial |
$301.41
|
| Rate for Payer: PACE Senior Care Partners |
$87.30
|
| Rate for Payer: PACE SWMI |
$91.89
|
| Rate for Payer: PHP Commercial |
$312.43
|
| Rate for Payer: PHP Medicare Advantage |
$91.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.92
|
| Rate for Payer: Priority Health HMO/PPO |
$319.79
|
| Rate for Payer: Priority Health Medicare |
$92.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.27
|
| Rate for Payer: Railroad Medicare Medicare |
$91.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.46
|
| Rate for Payer: UHC Core |
$306.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.89
|
| Rate for Payer: UHC Exchange |
$91.89
|
| Rate for Payer: UHC Medicare Advantage |
$91.89
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$91.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.68
|
|
