|
HC XR TEETH COMPLETE FULL MOUTH
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
CPT 70320
|
| Hospital Charge Code |
32000020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$201.46 |
| 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 |
$179.80
|
| 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 |
$201.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.89
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.76
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| 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 |
$171.23
|
| 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 |
$171.23
|
| Rate for Payer: VA VA |
$55.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.89
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
IP
|
$169.28
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.03 |
| Max. Negotiated Rate |
$152.35 |
| Rate for Payer: Aetna Commercial |
$143.89
|
| Rate for Payer: BCBS Trust/PPO |
$138.18
|
| Rate for Payer: BCN Commercial |
$130.82
|
| Rate for Payer: Cash Price |
$135.42
|
| Rate for Payer: Cofinity Commercial |
$145.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.42
|
| Rate for Payer: Healthscope Commercial |
$152.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$138.81
|
| Rate for Payer: PHP Commercial |
$143.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.03
|
| Rate for Payer: Priority Health HMO/PPO |
$147.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.97
|
| Rate for Payer: UHC Core |
$141.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.96
|
|
|
HC XR TEETH PARTIAL FULL MOUTH
|
Facility
|
OP
|
$169.28
|
|
|
Service Code
|
CPT 70310
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$179.80 |
| Rate for Payer: Aetna Commercial |
$143.89
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.90
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$42.32
|
| Rate for Payer: BCBS Trust/PPO |
$139.17
|
| Rate for Payer: BCN Commercial |
$131.62
|
| Rate for Payer: BCN Medicare Advantage |
$42.32
|
| Rate for Payer: Cash Price |
$135.42
|
| Rate for Payer: Cash Price |
$135.42
|
| Rate for Payer: Cofinity Commercial |
$145.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.32
|
| Rate for Payer: Healthscope Commercial |
$152.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.96
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.44
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$138.81
|
| Rate for Payer: PACE Senior Care Partners |
$40.20
|
| Rate for Payer: PACE SWMI |
$42.32
|
| Rate for Payer: PHP Commercial |
$143.89
|
| Rate for Payer: PHP Medicare Advantage |
$42.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.03
|
| Rate for Payer: Priority Health HMO/PPO |
$147.27
|
| Rate for Payer: Priority Health Medicare |
$42.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.42
|
| Rate for Payer: Railroad Medicare Medicare |
$42.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.97
|
| Rate for Payer: UHC Core |
$141.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.32
|
| Rate for Payer: UHC Exchange |
$42.32
|
| Rate for Payer: UHC Medicare Advantage |
$42.32
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$42.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.96
|
|
|
HC XR TIB FIB 2 VIEWS
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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 TIB FIB 2 VIEWS
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000112
|
|
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 TIB FIB BIL 2 VW
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: BCBS Trust/PPO |
$317.30
|
| Rate for Payer: BCN Commercial |
$300.40
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC XR TIB FIB BIL 2 VW
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
32000113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$101.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.47
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$97.18
|
| Rate for Payer: BCBS Trust/PPO |
$319.56
|
| Rate for Payer: BCN Commercial |
$302.22
|
| Rate for Payer: BCN Medicare Advantage |
$97.18
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.04
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Senior Care Partners |
$92.32
|
| Rate for Payer: PACE SWMI |
$97.18
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$98.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: Railroad Medicare Medicare |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.18
|
| Rate for Payer: UHC Exchange |
$97.18
|
| Rate for Payer: UHC Medicare Advantage |
$97.18
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$97.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC XR TMJ COMPLETE BIL
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
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 TMJ COMPLETE BIL
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
32000022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.37 |
| 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 |
$65.50
|
| 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 |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| 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 |
$62.37
|
| 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 |
$62.37
|
| Rate for Payer: VA VA |
$102.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR TMJ LTD
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: BCBS Trust/PPO |
$91.10
|
| Rate for Payer: BCN Commercial |
$86.24
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO |
$97.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.21
|
| Rate for Payer: UHC Core |
$93.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
|
HC XR TMJ LTD
|
Facility
|
OP
|
$111.60
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
32000021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.88
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$27.90
|
| Rate for Payer: BCBS Trust/PPO |
$91.75
|
| Rate for Payer: BCN Commercial |
$86.77
|
| Rate for Payer: BCN Medicare Advantage |
$27.90
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.90
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.30
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: PACE Senior Care Partners |
$26.50
|
| Rate for Payer: PACE SWMI |
$27.90
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: PHP Medicare Advantage |
$27.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO |
$97.09
|
| Rate for Payer: Priority Health Medicare |
$28.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.21
|
| Rate for Payer: UHC Core |
$93.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.90
|
| Rate for Payer: UHC Exchange |
$27.90
|
| Rate for Payer: UHC Medicare Advantage |
$27.90
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$27.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
|
HC XR TOES BIL MIN 2 VIEWS
|
Facility
|
IP
|
$223.85
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$201.46 |
| 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 |
$201.46
|
| 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 TOES BIL MIN 2 VIEWS
|
Facility
|
OP
|
$223.85
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$201.46 |
| 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 |
$65.50
|
| 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 |
$201.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.89
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.76
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| 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 |
$62.37
|
| 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 |
$62.37
|
| Rate for Payer: VA VA |
$55.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.89
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
OP
|
$194.04
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
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 |
$65.50
|
| 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 |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.94
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| 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 |
$62.37
|
| 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 |
$62.37
|
| Rate for Payer: VA VA |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.53
|
|
|
HC XR TOES MIN 2 VIEWS
|
Facility
|
IP
|
$194.04
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
32000130
|
|
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 UGI GASTRO THIN BARM
|
Facility
|
IP
|
$296.20
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.53 |
| Max. Negotiated Rate |
$266.58 |
| Rate for Payer: Aetna Commercial |
$251.77
|
| Rate for Payer: BCBS Trust/PPO |
$241.79
|
| Rate for Payer: BCN Commercial |
$228.90
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cofinity Commercial |
$254.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.96
|
| Rate for Payer: Healthscope Commercial |
$266.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.77
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| Rate for Payer: PHP Commercial |
$251.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.53
|
| Rate for Payer: Priority Health HMO/PPO |
$257.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.66
|
| Rate for Payer: UHC Core |
$247.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.15
|
|
|
HC XR UGI GASTRO THIN BARM
|
Facility
|
OP
|
$296.20
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$266.58 |
| Rate for Payer: Aetna Commercial |
$251.77
|
| Rate for Payer: Aetna Medicare |
$77.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.56
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$74.05
|
| Rate for Payer: BCBS Trust/PPO |
$243.51
|
| Rate for Payer: BCN Commercial |
$230.30
|
| Rate for Payer: BCN Medicare Advantage |
$74.05
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cash Price |
$236.96
|
| Rate for Payer: Cofinity Commercial |
$254.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.05
|
| Rate for Payer: Healthscope Commercial |
$266.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.15
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.75
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.77
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| Rate for Payer: PACE Senior Care Partners |
$70.35
|
| Rate for Payer: PACE SWMI |
$74.05
|
| Rate for Payer: PHP Commercial |
$251.77
|
| Rate for Payer: PHP Medicare Advantage |
$74.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.53
|
| Rate for Payer: Priority Health HMO/PPO |
$257.69
|
| Rate for Payer: Priority Health Medicare |
$74.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.45
|
| Rate for Payer: Railroad Medicare Medicare |
$74.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.66
|
| Rate for Payer: UHC Core |
$247.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.05
|
| Rate for Payer: UHC Exchange |
$74.05
|
| Rate for Payer: UHC Medicare Advantage |
$74.05
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$74.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.15
|
|
|
HC XR UPPER GI
|
Facility
|
IP
|
$583.54
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$379.30 |
| Max. Negotiated Rate |
$525.19 |
| Rate for Payer: Aetna Commercial |
$496.01
|
| Rate for Payer: BCBS Trust/PPO |
$476.34
|
| Rate for Payer: BCN Commercial |
$450.96
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$501.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.83
|
| Rate for Payer: Healthscope Commercial |
$525.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.01
|
| Rate for Payer: Nomi Health Commercial |
$478.50
|
| Rate for Payer: PHP Commercial |
$496.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO |
$507.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.52
|
| Rate for Payer: UHC Core |
$487.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.66
|
|
|
HC XR UPPER GI
|
Facility
|
OP
|
$583.54
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$525.19 |
| Rate for Payer: Aetna Commercial |
$496.01
|
| Rate for Payer: Aetna Medicare |
$151.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.36
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$145.88
|
| Rate for Payer: BCBS Trust/PPO |
$479.73
|
| Rate for Payer: BCN Commercial |
$453.70
|
| Rate for Payer: BCN Medicare Advantage |
$145.88
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cash Price |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$501.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.88
|
| Rate for Payer: Healthscope Commercial |
$525.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.66
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.18
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.01
|
| Rate for Payer: Nomi Health Commercial |
$478.50
|
| Rate for Payer: PACE Senior Care Partners |
$138.59
|
| Rate for Payer: PACE SWMI |
$145.88
|
| Rate for Payer: PHP Commercial |
$496.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO |
$507.68
|
| Rate for Payer: Priority Health Medicare |
$147.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.97
|
| Rate for Payer: Railroad Medicare Medicare |
$145.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.52
|
| Rate for Payer: UHC Core |
$487.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.88
|
| Rate for Payer: UHC Exchange |
$145.88
|
| Rate for Payer: UHC Medicare Advantage |
$145.88
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$145.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.66
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
OP
|
$509.20
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$458.28 |
| Rate for Payer: Aetna Commercial |
$432.82
|
| Rate for Payer: Aetna Medicare |
$132.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.12
|
| Rate for Payer: BCBS Complete |
$179.80
|
| Rate for Payer: BCBS MAPPO |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$418.61
|
| Rate for Payer: BCN Commercial |
$395.90
|
| Rate for Payer: BCN Medicare Advantage |
$127.30
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cofinity Commercial |
$437.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$458.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.90
|
| Rate for Payer: Mclaren Medicaid |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.66
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.82
|
| Rate for Payer: Nomi Health Commercial |
$417.54
|
| Rate for Payer: PACE Senior Care Partners |
$120.94
|
| Rate for Payer: PACE SWMI |
$127.30
|
| Rate for Payer: PHP Commercial |
$432.82
|
| Rate for Payer: PHP Medicare Advantage |
$127.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.98
|
| Rate for Payer: Priority Health HMO/PPO |
$443.00
|
| Rate for Payer: Priority Health Medicare |
$128.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.16
|
| Rate for Payer: Railroad Medicare Medicare |
$127.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.10
|
| Rate for Payer: UHC Core |
$425.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.30
|
| Rate for Payer: UHC Exchange |
$127.30
|
| Rate for Payer: UHC Medicare Advantage |
$127.30
|
| Rate for Payer: UHCCP Medicaid |
$171.23
|
| Rate for Payer: VA VA |
$127.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.90
|
|
|
HC XR URETHROGRAM RETROGRADE
|
Facility
|
IP
|
$509.20
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.98 |
| Max. Negotiated Rate |
$458.28 |
| Rate for Payer: Aetna Commercial |
$432.82
|
| Rate for Payer: BCBS Trust/PPO |
$415.66
|
| Rate for Payer: BCN Commercial |
$393.51
|
| Rate for Payer: Cash Price |
$407.36
|
| Rate for Payer: Cofinity Commercial |
$437.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.36
|
| Rate for Payer: Healthscope Commercial |
$458.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.82
|
| Rate for Payer: Nomi Health Commercial |
$417.54
|
| Rate for Payer: PHP Commercial |
$432.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.98
|
| Rate for Payer: Priority Health HMO/PPO |
$443.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.10
|
| Rate for Payer: UHC Core |
$425.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.90
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
OP
|
$792.88
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$713.59 |
| Rate for Payer: Aetna Commercial |
$673.95
|
| Rate for Payer: Aetna Medicare |
$206.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.78
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$198.22
|
| Rate for Payer: BCBS Trust/PPO |
$651.83
|
| Rate for Payer: BCN Commercial |
$616.46
|
| Rate for Payer: BCN Medicare Advantage |
$198.22
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cofinity Commercial |
$681.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.22
|
| Rate for Payer: Healthscope Commercial |
$713.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.66
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.13
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.95
|
| Rate for Payer: Nomi Health Commercial |
$650.16
|
| Rate for Payer: PACE Senior Care Partners |
$188.31
|
| Rate for Payer: PACE SWMI |
$198.22
|
| Rate for Payer: PHP Commercial |
$673.95
|
| Rate for Payer: PHP Medicare Advantage |
$198.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.37
|
| Rate for Payer: Priority Health HMO/PPO |
$689.81
|
| Rate for Payer: Priority Health Medicare |
$200.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.23
|
| Rate for Payer: Railroad Medicare Medicare |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.73
|
| Rate for Payer: UHC Core |
$662.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.22
|
| Rate for Payer: UHC Exchange |
$198.22
|
| Rate for Payer: UHC Medicare Advantage |
$198.22
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$198.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.66
|
|
|
HC XR UROGRAPHY INF
|
Facility
|
IP
|
$792.88
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$515.37 |
| Max. Negotiated Rate |
$713.59 |
| Rate for Payer: Aetna Commercial |
$673.95
|
| Rate for Payer: BCBS Trust/PPO |
$647.23
|
| Rate for Payer: BCN Commercial |
$612.74
|
| Rate for Payer: Cash Price |
$634.30
|
| Rate for Payer: Cofinity Commercial |
$681.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.30
|
| Rate for Payer: Healthscope Commercial |
$713.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.95
|
| Rate for Payer: Nomi Health Commercial |
$650.16
|
| Rate for Payer: PHP Commercial |
$673.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.37
|
| Rate for Payer: Priority Health HMO/PPO |
$689.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.73
|
| Rate for Payer: UHC Core |
$662.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.66
|
|
|
HC XR WRIST 2 VW
|
Facility
|
IP
|
$255.46
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$197.42
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: Nomi Health Commercial |
$209.48
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health HMO/PPO |
$222.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC Core |
$213.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.60
|
|
|
HC XR WRIST 2 VW
|
Facility
|
OP
|
$255.46
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna Medicare |
$66.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.83
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$63.86
|
| Rate for Payer: BCBS Trust/PPO |
$210.01
|
| Rate for Payer: BCN Commercial |
$198.62
|
| Rate for Payer: BCN Medicare Advantage |
$63.86
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.86
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.60
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.06
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: Nomi Health Commercial |
$209.48
|
| Rate for Payer: PACE Senior Care Partners |
$60.67
|
| Rate for Payer: PACE SWMI |
$63.86
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: PHP Medicare Advantage |
$63.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health HMO/PPO |
$222.25
|
| Rate for Payer: Priority Health Medicare |
$64.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.16
|
| Rate for Payer: Railroad Medicare Medicare |
$63.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC Core |
$213.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.86
|
| Rate for Payer: UHC Exchange |
$63.86
|
| Rate for Payer: UHC Medicare Advantage |
$63.86
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$63.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.60
|
|
