|
HC XR OPTIC FORAMINA
|
Facility
|
IP
|
$272.22
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
32000286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.78 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna American Axle |
$176.94
|
| Rate for Payer: Aetna Commercial |
$231.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.94
|
| Rate for Payer: Cash Price |
$217.78
|
| Rate for Payer: Cofinity Commercial |
$190.55
|
| Rate for Payer: Cofinity Commercial |
$234.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.78
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.39
|
| Rate for Payer: PHP Commercial |
$231.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.94
|
| Rate for Payer: Priority Health SBD |
$171.50
|
| Rate for Payer: UMR Bronson Commercial |
$119.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.16
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
IP
|
$346.92
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$312.23 |
| Rate for Payer: Aetna American Axle |
$225.50
|
| Rate for Payer: Aetna Commercial |
$294.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.50
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$242.84
|
| Rate for Payer: Cofinity Commercial |
$298.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.54
|
| Rate for Payer: Healthscope Commercial |
$312.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.88
|
| Rate for Payer: PHP Commercial |
$294.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.50
|
| Rate for Payer: Priority Health SBD |
$218.56
|
| Rate for Payer: UMR Bronson Commercial |
$152.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.19
|
|
|
HC XR ORBITS COMP MIN 4 VW
|
Facility
|
OP
|
$346.92
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$312.23 |
| Rate for Payer: Aetna American Axle |
$225.50
|
| Rate for Payer: Aetna Commercial |
$294.88
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cash Price |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$298.35
|
| Rate for Payer: Cofinity Commercial |
$242.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$312.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.19
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.88
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$294.88
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.50
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$218.56
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$128.36
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.19
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.75 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UMR Bronson Commercial |
$149.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC XR OS CALCIS BIL MIN 2 VIEWS
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$125.93
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
OP
|
$306.43
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$275.79 |
| Rate for Payer: Aetna American Axle |
$199.18
|
| Rate for Payer: Aetna Commercial |
$260.47
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| 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 |
$85.87
|
| 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 |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.47
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$260.47
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.18
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$193.05
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$113.38
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.82
|
|
|
HC XR OS CALCIS MIN 2 VIEWS
|
Facility
|
IP
|
$306.43
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
32000128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 PELVIS 1 OR 2 VW
|
Facility
|
IP
|
$296.34
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.39 |
| Max. Negotiated Rate |
$266.71 |
| Rate for Payer: Aetna American Axle |
$192.62
|
| Rate for Payer: Aetna Commercial |
$251.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.62
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cofinity Commercial |
$207.44
|
| Rate for Payer: Cofinity Commercial |
$254.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.07
|
| Rate for Payer: Healthscope Commercial |
$266.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.89
|
| Rate for Payer: PHP Commercial |
$251.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.62
|
| Rate for Payer: Priority Health SBD |
$186.69
|
| Rate for Payer: UMR Bronson Commercial |
$130.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.25
|
|
|
HC XR PELVIS 1 OR 2 VW
|
Facility
|
OP
|
$296.34
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$291.93 |
| Rate for Payer: Aetna American Axle |
$192.62
|
| Rate for Payer: Aetna Commercial |
$251.89
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cash Price |
$237.07
|
| Rate for Payer: Cofinity Commercial |
$254.85
|
| Rate for Payer: Cofinity Commercial |
$207.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$266.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.25
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.89
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$251.89
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.62
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$186.69
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$109.65
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.25
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.61 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna American Axle |
$265.33
|
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: UMR Bronson Commercial |
$179.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR PELVIS MIN 3 VW
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna American Axle |
$265.33
|
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$151.03
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna American Axle |
$663.51
|
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: UMR Bronson Commercial |
$449.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna American Axle |
$663.51
|
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$331.81
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: UMR Bronson Commercial |
$377.69
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$583.79 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna American Axle |
$862.42
|
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$928.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health SBD |
$835.88
|
| Rate for Payer: UMR Bronson Commercial |
$583.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna American Axle |
$862.42
|
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$928.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$835.88
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$665.64
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: UMR Bronson Commercial |
$490.92
|
| Rate for Payer: VA VA |
$348.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC XR RIBS 2 VW
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
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 RIBS 2 VW
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna American Axle |
$232.30
|
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| 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: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$132.23
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Commercial |
$321.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.03
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
IP
|
$459.55
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$321.69
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: UMR Bronson Commercial |
$202.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
OP
|
$459.55
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Commercial |
$321.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$170.03
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
IP
|
$459.55
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$321.69
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: UMR Bronson Commercial |
$202.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna American Axle |
$265.33
|
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$151.03
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.61 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna American Axle |
$265.33
|
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.33
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$285.74
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health SBD |
$257.17
|
| Rate for Payer: UMR Bronson Commercial |
$179.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
OP
|
$188.76
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$291.93 |
| Rate for Payer: Aetna American Axle |
$122.69
|
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Cofinity Commercial |
$132.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.69
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$118.92
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$69.84
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
IP
|
$188.76
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna American Axle |
$122.69
|
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.69
|
| Rate for Payer: Priority Health SBD |
$118.92
|
| Rate for Payer: UMR Bronson Commercial |
$83.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
