|
HC XR MANDIBLE MIN 4 VW
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna American Axle |
$292.85
|
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.43
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health SBD |
$283.84
|
| Rate for Payer: UMR Bronson Commercial |
$198.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.90
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$307.65 |
| Rate for Payer: Aetna American Axle |
$75.19
|
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$88.05
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.99
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$60.90
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$42.80
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
HC XR MASTOIDS 3 VW PER SIDE
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna American Axle |
$75.19
|
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Cofinity Commercial |
$80.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.32
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
OP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$307.65 |
| Rate for Payer: Aetna American Axle |
$71.12
|
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$68.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR MASTOIDS LESS THAN 3 VW
|
Facility
|
IP
|
$109.41
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$98.47 |
| Rate for Payer: Aetna American Axle |
$71.12
|
| Rate for Payer: Aetna Commercial |
$93.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.12
|
| Rate for Payer: Cash Price |
$87.53
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Cofinity Commercial |
$94.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.53
|
| Rate for Payer: Healthscope Commercial |
$98.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.00
|
| Rate for Payer: PHP Commercial |
$93.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.59
|
| Rate for Payer: Priority Health SBD |
$68.93
|
| Rate for Payer: UMR Bronson Commercial |
$48.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.06
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
OP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.80 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna American Axle |
$379.10
|
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.10
|
| Rate for Payer: BCBS Complete |
$233.29
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.58
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health SBD |
$367.43
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UMR Bronson Commercial |
$215.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.42
|
|
|
HC XR MED EXAM REVIEW
|
Facility
|
IP
|
$583.23
|
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$524.91 |
| Rate for Payer: Aetna American Axle |
$379.10
|
| Rate for Payer: Aetna Commercial |
$495.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.10
|
| Rate for Payer: Cash Price |
$466.58
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$501.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.58
|
| Rate for Payer: Healthscope Commercial |
$524.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$437.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$495.75
|
| Rate for Payer: PHP Commercial |
$495.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.26
|
| Rate for Payer: Priority Health SBD |
$367.43
|
| Rate for Payer: UMR Bronson Commercial |
$256.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$437.42
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$644.65
|
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$134.93
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$694.24
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.83
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$624.82
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.02
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$110.02
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$366.95
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.83
|
|
|
HC XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$991.77
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
32000053
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$436.38 |
| Max. Negotiated Rate |
$892.59 |
| Rate for Payer: Aetna American Axle |
$644.65
|
| Rate for Payer: Aetna Commercial |
$843.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.65
|
| Rate for Payer: Cash Price |
$793.42
|
| Rate for Payer: Cofinity Commercial |
$694.24
|
| Rate for Payer: Cofinity Commercial |
$852.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.42
|
| Rate for Payer: Healthscope Commercial |
$892.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.00
|
| Rate for Payer: PHP Commercial |
$843.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.24
|
| Rate for Payer: Priority Health SBD |
$624.82
|
| Rate for Payer: UMR Bronson Commercial |
$436.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.83
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
OP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.43 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna American Axle |
$86.65
|
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$43.07
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.98
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.27
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$203.42
|
| Rate for Payer: Priority Health SBD |
$83.99
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.57
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.77
|
| Rate for Payer: UHC Exchange |
$31.43
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: VA VA |
$80.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.98
|
|
|
HC XR NASAL FACIAL BONES LESS THAN 3 VW
|
Facility
|
IP
|
$133.31
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.66 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna American Axle |
$86.65
|
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.65
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health SBD |
$83.99
|
| Rate for Payer: UMR Bronson Commercial |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.98
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
IP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$528.32 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna American Axle |
$780.47
|
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.47
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Cofinity Commercial |
$840.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.58
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.61
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.50
|
| Rate for Payer: Priority Health SBD |
$756.45
|
| Rate for Payer: UMR Bronson Commercial |
$528.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.54
|
|
|
HC XR NEPHROTOMOGRAPHY
|
Facility
|
OP
|
$1,200.72
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,080.65 |
| Rate for Payer: Aetna American Axle |
$780.47
|
| Rate for Payer: Aetna Commercial |
$1,020.61
|
| Rate for Payer: Aetna Medicare |
$169.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$252.12
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.62
|
| Rate for Payer: Cofinity Commercial |
$840.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,080.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.54
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.61
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$1,020.61
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$514.13
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$411.30
|
| Rate for Payer: Priority Health SBD |
$756.45
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.32
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: UMR Bronson Commercial |
$444.27
|
| Rate for Payer: VA VA |
$163.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.54
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
OP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna American Axle |
$173.47
|
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$229.52
|
| Rate for Payer: Cofinity Commercial |
$186.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.16
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.85
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$226.85
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.27
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$203.42
|
| Rate for Payer: Priority Health SBD |
$168.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.77
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: UMR Bronson Commercial |
$98.75
|
| Rate for Payer: VA VA |
$80.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.16
|
|
|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$266.88
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$240.19 |
| Rate for Payer: Aetna American Axle |
$173.47
|
| Rate for Payer: Aetna Commercial |
$226.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.47
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$186.82
|
| Rate for Payer: Cofinity Commercial |
$229.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.50
|
| Rate for Payer: Healthscope Commercial |
$240.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.85
|
| Rate for Payer: PHP Commercial |
$226.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.82
|
| Rate for Payer: Priority Health SBD |
$168.13
|
| Rate for Payer: UMR Bronson Commercial |
$117.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.16
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$307.65 |
| Rate for Payer: Aetna American Axle |
$221.08
|
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$65.88
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.09
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$289.10
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$214.28
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$47.15
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$125.84
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.09
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$340.12
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.65 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Aetna American Axle |
$221.08
|
| Rate for Payer: Aetna Commercial |
$289.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.08
|
| Rate for Payer: Cash Price |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$292.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.10
|
| Rate for Payer: Healthscope Commercial |
$306.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.10
|
| Rate for Payer: PHP Commercial |
$289.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.08
|
| Rate for Payer: Priority Health SBD |
$214.28
|
| Rate for Payer: UMR Bronson Commercial |
$149.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.09
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.81 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: UMR Bronson Commercial |
$146.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$39.91
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.27
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$203.42
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: UMR Bronson Commercial |
$123.46
|
| Rate for Payer: VA VA |
$80.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna American Axle |
$195.27
|
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$39.91
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.27
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$203.42
|
| Rate for Payer: Priority Health SBD |
$189.26
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: UMR Bronson Commercial |
$111.16
|
| Rate for Payer: VA VA |
$80.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.18 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna American Axle |
$195.27
|
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.27
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$210.29
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health SBD |
$189.26
|
| Rate for Payer: UMR Bronson Commercial |
$132.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.83 |
| Max. Negotiated Rate |
$261.48 |
| Rate for Payer: Aetna American Axle |
$188.84
|
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.84
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$203.37
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.42
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.95
|
| Rate for Payer: PHP Commercial |
$246.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.37
|
| Rate for Payer: Priority Health SBD |
$183.03
|
| Rate for Payer: UMR Bronson Commercial |
$127.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.90
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$290.53
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$307.65 |
| Rate for Payer: Aetna American Axle |
$188.84
|
| Rate for Payer: Aetna Commercial |
$246.95
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$37.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cash Price |
$232.42
|
| Rate for Payer: Cofinity Commercial |
$203.37
|
| Rate for Payer: Cofinity Commercial |
$249.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$261.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.90
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.95
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$246.95
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$183.03
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$107.50
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.90
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna American Axle |
$260.13
|
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: UMR Bronson Commercial |
$176.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna American Axle |
$260.13
|
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.15
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$252.13
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.75
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$41.59
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$148.07
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.15
|
|
