|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
OP
|
$315.48
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.93 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Aetna Commercial |
$268.16
|
| Rate for Payer: Aetna Medicare |
$82.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.59
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$78.87
|
| Rate for Payer: BCBS Trust/PPO |
$245.29
|
| Rate for Payer: BCN Commercial |
$245.29
|
| Rate for Payer: BCN Medicare Advantage |
$78.87
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cofinity Commercial |
$271.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.87
|
| Rate for Payer: Healthscope Commercial |
$283.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.61
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.16
|
| Rate for Payer: PACE Senior Care Partners |
$74.93
|
| Rate for Payer: PACE SWMI |
$78.87
|
| Rate for Payer: PHP Commercial |
$268.16
|
| Rate for Payer: PHP Medicare Advantage |
$78.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.47
|
| Rate for Payer: Priority Health Medicare |
$78.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.41
|
| Rate for Payer: Railroad Medicare Medicare |
$78.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.62
|
| Rate for Payer: UHC Core |
$263.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.87
|
| Rate for Payer: UHC Medicare Advantage |
$81.24
|
| Rate for Payer: VA VA |
$78.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.61
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
OP
|
$420.24
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.81 |
| Max. Negotiated Rate |
$378.22 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Medicare |
$109.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.32
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$105.06
|
| Rate for Payer: BCBS Trust/PPO |
$326.74
|
| Rate for Payer: BCN Commercial |
$326.74
|
| Rate for Payer: BCN Medicare Advantage |
$105.06
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.06
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.18
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.20
|
| Rate for Payer: PACE Senior Care Partners |
$99.81
|
| Rate for Payer: PACE SWMI |
$105.06
|
| Rate for Payer: PHP Commercial |
$357.20
|
| Rate for Payer: PHP Medicare Advantage |
$105.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.61
|
| Rate for Payer: Priority Health Medicare |
$105.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.30
|
| Rate for Payer: Railroad Medicare Medicare |
$105.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.81
|
| Rate for Payer: UHC Core |
$350.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.06
|
| Rate for Payer: UHC Medicare Advantage |
$108.21
|
| Rate for Payer: VA VA |
$105.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.18
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
IP
|
$420.24
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.30 |
| Max. Negotiated Rate |
$378.22 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: BCBS Trust/PPO |
$324.76
|
| Rate for Payer: BCN Commercial |
$324.76
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.19
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.20
|
| Rate for Payer: PHP Commercial |
$357.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.81
|
| Rate for Payer: UHC Core |
$350.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.18
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$89.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.62
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$86.10
|
| Rate for Payer: BCBS Trust/PPO |
$267.76
|
| Rate for Payer: BCN Commercial |
$267.76
|
| Rate for Payer: BCN Medicare Advantage |
$86.10
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Senior Care Partners |
$81.79
|
| Rate for Payer: PACE SWMI |
$86.10
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: PHP Medicare Advantage |
$86.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Medicare |
$86.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: Railroad Medicare Medicare |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.10
|
| Rate for Payer: UHC Medicare Advantage |
$88.68
|
| Rate for Payer: VA VA |
$86.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: BCBS Trust/PPO |
$266.14
|
| Rate for Payer: BCN Commercial |
$266.14
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$89.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.62
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$86.10
|
| Rate for Payer: BCBS Trust/PPO |
$267.76
|
| Rate for Payer: BCN Commercial |
$267.76
|
| Rate for Payer: BCN Medicare Advantage |
$86.10
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Senior Care Partners |
$81.79
|
| Rate for Payer: PACE SWMI |
$86.10
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: PHP Medicare Advantage |
$86.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Medicare |
$86.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: Railroad Medicare Medicare |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.10
|
| Rate for Payer: UHC Medicare Advantage |
$88.68
|
| Rate for Payer: VA VA |
$86.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: BCBS Trust/PPO |
$266.14
|
| Rate for Payer: BCN Commercial |
$266.14
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: BCBS Trust/PPO |
$266.14
|
| Rate for Payer: BCN Commercial |
$266.14
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$89.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.62
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$86.10
|
| Rate for Payer: BCBS Trust/PPO |
$267.76
|
| Rate for Payer: BCN Commercial |
$267.76
|
| Rate for Payer: BCN Medicare Advantage |
$86.10
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.29
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Senior Care Partners |
$81.79
|
| Rate for Payer: PACE SWMI |
$86.10
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: PHP Medicare Advantage |
$86.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.62
|
| Rate for Payer: Priority Health Medicare |
$86.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.04
|
| Rate for Payer: Railroad Medicare Medicare |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.06
|
| Rate for Payer: UHC Core |
$287.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.10
|
| Rate for Payer: UHC Medicare Advantage |
$88.68
|
| Rate for Payer: VA VA |
$86.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.29
|
|
|
HC CLOSURE DEVICE
|
Facility
|
IP
|
$1,116.14
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.73 |
| Max. Negotiated Rate |
$1,004.53 |
| Rate for Payer: Aetna Commercial |
$948.72
|
| Rate for Payer: BCBS Trust/PPO |
$862.55
|
| Rate for Payer: BCN Commercial |
$862.55
|
| Rate for Payer: Cash Price |
$892.91
|
| Rate for Payer: Cofinity Commercial |
$959.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.91
|
| Rate for Payer: Healthscope Commercial |
$1,004.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$837.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$948.72
|
| Rate for Payer: PHP Commercial |
$948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$680.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$982.20
|
| Rate for Payer: UHC Core |
$931.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$837.10
|
|
|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,116.14
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.08 |
| Max. Negotiated Rate |
$1,004.53 |
| Rate for Payer: Aetna Commercial |
$948.72
|
| Rate for Payer: Aetna Medicare |
$290.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.79
|
| Rate for Payer: BCBS Complete |
$446.46
|
| Rate for Payer: BCBS MAPPO |
$279.04
|
| Rate for Payer: BCBS Trust/PPO |
$867.80
|
| Rate for Payer: BCN Commercial |
$867.80
|
| Rate for Payer: BCN Medicare Advantage |
$279.04
|
| Rate for Payer: Cash Price |
$892.91
|
| Rate for Payer: Cofinity Commercial |
$959.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.04
|
| Rate for Payer: Healthscope Commercial |
$1,004.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$837.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$948.72
|
| Rate for Payer: PACE Senior Care Partners |
$265.08
|
| Rate for Payer: PACE SWMI |
$279.04
|
| Rate for Payer: PHP Commercial |
$948.72
|
| Rate for Payer: PHP Medicare Advantage |
$279.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.04
|
| Rate for Payer: Priority Health Medicare |
$279.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$680.73
|
| Rate for Payer: Railroad Medicare Medicare |
$279.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$982.20
|
| Rate for Payer: UHC Core |
$931.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.04
|
| Rate for Payer: UHC Medicare Advantage |
$287.41
|
| Rate for Payer: VA VA |
$279.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$837.10
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$35.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$14.87
|
| Rate for Payer: Meridian Medicaid |
$15.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.94 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: BCBS Trust/PPO |
$463.68
|
| Rate for Payer: BCN Commercial |
$463.68
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.00
|
| Rate for Payer: UHC Core |
$501.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.00
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.50
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$150.00
|
| Rate for Payer: BCBS Trust/PPO |
$466.50
|
| Rate for Payer: BCN Commercial |
$466.50
|
| Rate for Payer: BCN Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.00
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PACE Senior Care Partners |
$142.50
|
| Rate for Payer: PACE SWMI |
$150.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: PHP Medicare Advantage |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.00
|
| Rate for Payer: Priority Health Medicare |
$150.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.94
|
| Rate for Payer: Railroad Medicare Medicare |
$150.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.00
|
| Rate for Payer: UHC Core |
$501.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.50
|
| Rate for Payer: VA VA |
$150.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.00
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna Medicare |
$161.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$194.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$194.58
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$155.66
|
| Rate for Payer: BCBS Trust/PPO |
$484.12
|
| Rate for Payer: BCN Commercial |
$484.12
|
| Rate for Payer: BCN Medicare Advantage |
$155.66
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.66
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.00
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PACE Senior Care Partners |
$147.88
|
| Rate for Payer: PACE SWMI |
$155.66
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$155.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.71
|
| Rate for Payer: Priority Health Medicare |
$155.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.76
|
| Rate for Payer: Railroad Medicare Medicare |
$155.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.94
|
| Rate for Payer: UHC Core |
$519.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.66
|
| Rate for Payer: UHC Medicare Advantage |
$160.33
|
| Rate for Payer: VA VA |
$155.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.00
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: BCBS Trust/PPO |
$481.19
|
| Rate for Payer: BCN Commercial |
$481.19
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.94
|
| Rate for Payer: UHC Core |
$519.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.00
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: BCBS Trust/PPO |
$481.19
|
| Rate for Payer: BCN Commercial |
$481.19
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.94
|
| Rate for Payer: UHC Core |
$519.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.00
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna Medicare |
$161.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$194.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$194.58
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$155.66
|
| Rate for Payer: BCBS Trust/PPO |
$484.12
|
| Rate for Payer: BCN Commercial |
$484.12
|
| Rate for Payer: BCN Medicare Advantage |
$155.66
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.66
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.00
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PACE Senior Care Partners |
$147.88
|
| Rate for Payer: PACE SWMI |
$155.66
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$155.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.71
|
| Rate for Payer: Priority Health Medicare |
$155.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.76
|
| Rate for Payer: Railroad Medicare Medicare |
$155.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.94
|
| Rate for Payer: UHC Core |
$519.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.66
|
| Rate for Payer: UHC Medicare Advantage |
$160.33
|
| Rate for Payer: VA VA |
$155.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.00
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
IP
|
$322.07
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.43 |
| Max. Negotiated Rate |
$289.86 |
| Rate for Payer: Aetna Commercial |
$273.76
|
| Rate for Payer: BCBS Trust/PPO |
$248.90
|
| Rate for Payer: BCN Commercial |
$248.90
|
| Rate for Payer: Cash Price |
$257.66
|
| Rate for Payer: Cofinity Commercial |
$276.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$289.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.76
|
| Rate for Payer: PHP Commercial |
$273.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.42
|
| Rate for Payer: UHC Core |
$268.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.55
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
OP
|
$322.07
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.49 |
| Max. Negotiated Rate |
$289.86 |
| Rate for Payer: Aetna Commercial |
$273.76
|
| Rate for Payer: Aetna Medicare |
$83.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.65
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$80.52
|
| Rate for Payer: BCBS Trust/PPO |
$250.41
|
| Rate for Payer: BCN Commercial |
$250.41
|
| Rate for Payer: BCN Medicare Advantage |
$80.52
|
| Rate for Payer: Cash Price |
$257.66
|
| Rate for Payer: Cash Price |
$257.66
|
| Rate for Payer: Cofinity Commercial |
$276.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.52
|
| Rate for Payer: Healthscope Commercial |
$289.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.55
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.76
|
| Rate for Payer: PACE Senior Care Partners |
$76.49
|
| Rate for Payer: PACE SWMI |
$80.52
|
| Rate for Payer: PHP Commercial |
$273.76
|
| Rate for Payer: PHP Medicare Advantage |
$80.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.20
|
| Rate for Payer: Priority Health Medicare |
$80.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.43
|
| Rate for Payer: Railroad Medicare Medicare |
$80.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.42
|
| Rate for Payer: UHC Core |
$268.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.52
|
| Rate for Payer: UHC Medicare Advantage |
$82.93
|
| Rate for Payer: VA VA |
$80.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.55
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.50
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$150.00
|
| Rate for Payer: BCBS Trust/PPO |
$466.50
|
| Rate for Payer: BCN Commercial |
$466.50
|
| Rate for Payer: BCN Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.00
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PACE Senior Care Partners |
$142.50
|
| Rate for Payer: PACE SWMI |
$150.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: PHP Medicare Advantage |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.00
|
| Rate for Payer: Priority Health Medicare |
$150.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.94
|
| Rate for Payer: Railroad Medicare Medicare |
$150.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.00
|
| Rate for Payer: UHC Core |
$501.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.50
|
| Rate for Payer: VA VA |
$150.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.00
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.94 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: BCBS Trust/PPO |
$463.68
|
| Rate for Payer: BCN Commercial |
$463.68
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.00
|
| Rate for Payer: UHC Core |
$501.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.00
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
IP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.01 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$119.88
|
| Rate for Payer: BCBS Trust/PPO |
$108.99
|
| Rate for Payer: BCN Commercial |
$108.99
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.88
|
| Rate for Payer: PHP Commercial |
$119.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.11
|
| Rate for Payer: UHC Core |
$117.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.77
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
OP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$119.88
|
| Rate for Payer: Aetna Medicare |
$36.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.07
|
| Rate for Payer: BCBS Complete |
$56.41
|
| Rate for Payer: BCBS MAPPO |
$35.26
|
| Rate for Payer: BCBS Trust/PPO |
$109.65
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$109.65
|
| Rate for Payer: BCN Medicare Advantage |
$35.26
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.26
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.88
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.26
|
| Rate for Payer: PHP Commercial |
$119.88
|
| Rate for Payer: PHP Medicare Advantage |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.70
|
| Rate for Payer: Priority Health Medicare |
$35.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.01
|
| Rate for Payer: Railroad Medicare Medicare |
$35.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.11
|
| Rate for Payer: UHC Core |
$117.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.26
|
| Rate for Payer: UHC Medicare Advantage |
$36.32
|
| Rate for Payer: VA VA |
$35.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.77
|
|
