|
HC XR ANKLE MIN 3 VIEWS
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
32000121
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna American Axle |
$232.30
|
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
| Rate for Payer: UMR Bronson Commercial |
$157.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC XR ARTHROGRAM ELBOW
|
Facility
|
OP
|
$612.31
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.41 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$153.25
|
| Rate for Payer: BCN Commercial |
$153.25
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.55
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$91.41
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$226.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM ELBOW
|
Facility
|
IP
|
$612.31
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.42 |
| Max. Negotiated Rate |
$551.08 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: UMR Bronson Commercial |
$269.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM HIP
|
Facility
|
OP
|
$612.31
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$207.31
|
| Rate for Payer: BCN Commercial |
$207.31
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.28
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$117.53
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$226.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM HIP
|
Facility
|
IP
|
$612.31
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.42 |
| Max. Negotiated Rate |
$551.08 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: UMR Bronson Commercial |
$269.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM KNEE
|
Facility
|
OP
|
$612.31
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$164.89
|
| Rate for Payer: BCN Commercial |
$164.89
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.50
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$101.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$226.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM KNEE
|
Facility
|
IP
|
$612.31
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.42 |
| Max. Negotiated Rate |
$551.08 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: UMR Bronson Commercial |
$269.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM SHOULDER
|
Facility
|
IP
|
$612.31
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
32000067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.42 |
| Max. Negotiated Rate |
$551.08 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: UMR Bronson Commercial |
$269.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM SHOULDER
|
Facility
|
OP
|
$612.31
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
32000067
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna American Axle |
$398.00
|
| Rate for Payer: Aetna Commercial |
$520.46
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.20
|
| Rate for Payer: BCN Commercial |
$216.20
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cash Price |
$489.85
|
| Rate for Payer: Cofinity Commercial |
$526.59
|
| Rate for Payer: Cofinity Commercial |
$428.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$551.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.23
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.46
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$520.46
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$119.75
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$226.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.23
|
|
|
HC XR ARTHROGRAM WRIST
|
Facility
|
IP
|
$670.87
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
32000084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.18 |
| Max. Negotiated Rate |
$603.78 |
| Rate for Payer: Aetna American Axle |
$436.07
|
| Rate for Payer: Aetna Commercial |
$570.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.07
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cofinity Commercial |
$469.61
|
| Rate for Payer: Cofinity Commercial |
$576.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.70
|
| Rate for Payer: Healthscope Commercial |
$603.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.24
|
| Rate for Payer: PHP Commercial |
$570.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.07
|
| Rate for Payer: Priority Health SBD |
$422.65
|
| Rate for Payer: UMR Bronson Commercial |
$295.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.15
|
|
|
HC XR ARTHROGRAM WRIST
|
Facility
|
OP
|
$670.87
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
32000084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.73 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna American Axle |
$436.07
|
| Rate for Payer: Aetna Commercial |
$570.24
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$222.36
|
| Rate for Payer: BCN Commercial |
$222.36
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cofinity Commercial |
$576.95
|
| Rate for Payer: Cofinity Commercial |
$469.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$603.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.15
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.24
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$570.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$422.65
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.00
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$122.73
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UMR Bronson Commercial |
$248.22
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.15
|
|
|
HC XR BONE AGE STUDY
|
Facility
|
IP
|
$306.43
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
32000253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.83 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna American Axle |
$199.18
|
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.18
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$214.50
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health SBD |
$193.05
|
| Rate for Payer: UMR Bronson Commercial |
$134.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR BONE AGE STUDY
|
Facility
|
OP
|
$306.43
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
32000253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$327.48 |
| Rate for Payer: Aetna American Axle |
$199.18
|
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cash Price |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$263.53
|
| Rate for Payer: Cofinity Commercial |
$214.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.82
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$193.05
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$23.99
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$113.38
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR BONE LENGTH STUDY
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna American Axle |
$189.70
|
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health SBD |
$183.86
|
| Rate for Payer: UMR Bronson Commercial |
$128.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC XR BONE LENGTH STUDY
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$327.48 |
| Rate for Payer: Aetna American Axle |
$189.70
|
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$66.36
|
| Rate for Payer: BCN Commercial |
$66.36
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$183.86
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.74
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$41.58
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$107.98
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC XR BONE SURVEY ADULT COMP
|
Facility
|
OP
|
$612.56
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
32000257
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$551.30 |
| Rate for Payer: Aetna American Axle |
$398.16
|
| Rate for Payer: Aetna Commercial |
$520.68
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$151.20
|
| Rate for Payer: BCN Commercial |
$151.20
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cofinity Commercial |
$526.80
|
| Rate for Payer: Cofinity Commercial |
$428.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$551.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.42
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.68
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$520.68
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$385.91
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.34
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$91.22
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$226.65
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.42
|
|
|
HC XR BONE SURVEY ADULT COMP
|
Facility
|
IP
|
$612.56
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
32000257
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.53 |
| Max. Negotiated Rate |
$551.30 |
| Rate for Payer: Aetna American Axle |
$398.16
|
| Rate for Payer: Aetna Commercial |
$520.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.16
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cofinity Commercial |
$428.79
|
| Rate for Payer: Cofinity Commercial |
$526.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.05
|
| Rate for Payer: Healthscope Commercial |
$551.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.68
|
| Rate for Payer: PHP Commercial |
$520.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.16
|
| Rate for Payer: Priority Health SBD |
$385.91
|
| Rate for Payer: UMR Bronson Commercial |
$269.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.42
|
|
|
HC XR BONE SURVEY INFANT
|
Facility
|
OP
|
$387.96
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
32000258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$349.16 |
| Rate for Payer: Aetna American Axle |
$252.17
|
| Rate for Payer: Aetna Commercial |
$329.77
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$152.57
|
| Rate for Payer: BCN Commercial |
$152.57
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$310.37
|
| Rate for Payer: Cash Price |
$310.37
|
| Rate for Payer: Cofinity Commercial |
$333.65
|
| Rate for Payer: Cofinity Commercial |
$271.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$349.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.97
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$329.77
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$244.41
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.47
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$98.61
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$143.55
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.97
|
|
|
HC XR BONE SURVEY INFANT
|
Facility
|
IP
|
$387.96
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
32000258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.70 |
| Max. Negotiated Rate |
$349.16 |
| Rate for Payer: Aetna American Axle |
$252.17
|
| Rate for Payer: Aetna Commercial |
$329.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.17
|
| Rate for Payer: Cash Price |
$310.37
|
| Rate for Payer: Cofinity Commercial |
$271.57
|
| Rate for Payer: Cofinity Commercial |
$333.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.37
|
| Rate for Payer: Healthscope Commercial |
$349.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: PHP Commercial |
$329.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.17
|
| Rate for Payer: Priority Health SBD |
$244.41
|
| Rate for Payer: UMR Bronson Commercial |
$170.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.97
|
|
|
HC XR BONE SURVEY (METS) LTD
|
Facility
|
IP
|
$308.12
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
32000298
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$277.31 |
| Rate for Payer: Aetna American Axle |
$200.28
|
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.28
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cofinity Commercial |
$215.68
|
| Rate for Payer: Cofinity Commercial |
$264.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.50
|
| Rate for Payer: Healthscope Commercial |
$277.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.90
|
| Rate for Payer: PHP Commercial |
$261.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health SBD |
$194.12
|
| Rate for Payer: UMR Bronson Commercial |
$135.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.09
|
|
|
HC XR BONE SURVEY (METS) LTD
|
Facility
|
OP
|
$308.12
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
32000298
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$327.48 |
| Rate for Payer: Aetna American Axle |
$200.28
|
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$91.68
|
| Rate for Payer: BCN Commercial |
$91.68
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cofinity Commercial |
$264.98
|
| Rate for Payer: Cofinity Commercial |
$215.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$277.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.09
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.90
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$261.90
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$194.12
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.01
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$60.01
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$114.00
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.09
|
|
|
HC XR CHEST 2 VIEWS
|
Facility
|
OP
|
$303.69
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
32400010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$273.32 |
| Rate for Payer: Aetna American Axle |
$197.40
|
| Rate for Payer: Aetna Commercial |
$258.14
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$47.89
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$242.95
|
| Rate for Payer: Cash Price |
$242.95
|
| Rate for Payer: Cofinity Commercial |
$261.17
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$273.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.77
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.14
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$258.14
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.03
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$30.94
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: UMR Bronson Commercial |
$112.37
|
| Rate for Payer: VA VA |
$86.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.77
|
|
|
HC XR CHEST 2 VIEWS
|
Facility
|
IP
|
$303.69
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
32400010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$133.62 |
| Max. Negotiated Rate |
$273.32 |
| Rate for Payer: Aetna American Axle |
$197.40
|
| Rate for Payer: Aetna Commercial |
$258.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.40
|
| Rate for Payer: Cash Price |
$242.95
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Commercial |
$261.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.95
|
| Rate for Payer: Healthscope Commercial |
$273.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.14
|
| Rate for Payer: PHP Commercial |
$258.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: UMR Bronson Commercial |
$133.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.77
|
|
|
HC XR CHEST 3 VIEWS
|
Facility
|
IP
|
$336.47
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
32400011
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$148.05 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna American Axle |
$218.71
|
| Rate for Payer: Aetna Commercial |
$286.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.71
|
| Rate for Payer: Cash Price |
$269.18
|
| Rate for Payer: Cofinity Commercial |
$235.53
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.18
|
| Rate for Payer: Healthscope Commercial |
$302.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.00
|
| Rate for Payer: PHP Commercial |
$286.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.71
|
| Rate for Payer: Priority Health SBD |
$211.98
|
| Rate for Payer: UMR Bronson Commercial |
$148.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.35
|
|
|
HC XR CHEST 3 VIEWS
|
Facility
|
OP
|
$336.47
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
32400011
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna American Axle |
$218.71
|
| Rate for Payer: Aetna Commercial |
$286.00
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$60.21
|
| Rate for Payer: BCN Commercial |
$60.21
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$269.18
|
| Rate for Payer: Cash Price |
$269.18
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Cofinity Commercial |
$235.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$302.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.35
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.00
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$286.00
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$211.98
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$38.84
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: UMR Bronson Commercial |
$124.49
|
| Rate for Payer: VA VA |
$86.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.35
|
|
