|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
OP
|
$368.03
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$331.23 |
| Rate for Payer: Aetna Commercial |
$312.83
|
| Rate for Payer: Aetna Medicare |
$95.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.01
|
| Rate for Payer: BCBS Complete |
$68.12
|
| Rate for Payer: BCBS MAPPO |
$92.01
|
| Rate for Payer: BCBS Trust/PPO |
$302.56
|
| Rate for Payer: BCN Commercial |
$302.56
|
| Rate for Payer: BCN Medicare Advantage |
$92.01
|
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.01
|
| Rate for Payer: Healthscope Commercial |
$331.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.02
|
| Rate for Payer: Mclaren Medicaid |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.61
|
| Rate for Payer: Meridian Medicaid |
$68.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.83
|
| Rate for Payer: Nomi Health Commercial |
$301.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.02
|
| Rate for Payer: PACE Senior Care Partners |
$87.41
|
| Rate for Payer: PACE SWMI |
$92.01
|
| Rate for Payer: PHP Commercial |
$312.83
|
| Rate for Payer: PHP Medicare Advantage |
$92.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.19
|
| Rate for Payer: Priority Health Medicare |
$92.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.15
|
| Rate for Payer: Railroad Medicare Medicare |
$92.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.87
|
| Rate for Payer: UHC Core |
$307.31
|
| Rate for Payer: UHC Exchange |
$92.01
|
| Rate for Payer: UHC Medicaid |
$64.88
|
| Rate for Payer: UHC Medicare Advantage |
$92.01
|
| Rate for Payer: UHCCP Medicaid |
$64.88
|
| Rate for Payer: VA VA |
$92.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.02
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
IP
|
$368.03
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.15 |
| Max. Negotiated Rate |
$331.23 |
| Rate for Payer: Aetna Commercial |
$312.83
|
| Rate for Payer: BCBS Trust/PPO |
$303.96
|
| Rate for Payer: BCN Commercial |
$303.96
|
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.42
|
| Rate for Payer: Healthscope Commercial |
$331.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.83
|
| Rate for Payer: Nomi Health Commercial |
$301.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.02
|
| Rate for Payer: PHP Commercial |
$312.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.87
|
| Rate for Payer: UHC Core |
$307.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.02
|
|
|
HC CLOSED RX INTER/PERI/SUB-TROCHANTERIC FEM FX W/O MANIP
|
Facility
|
IP
|
$4,938.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,436.85 |
| Max. Negotiated Rate |
$4,444.20 |
| Rate for Payer: Aetna Commercial |
$4,197.30
|
| Rate for Payer: BCBS Trust/PPO |
$4,078.29
|
| Rate for Payer: BCN Commercial |
$4,078.29
|
| Rate for Payer: Cash Price |
$3,950.40
|
| Rate for Payer: Cofinity Commercial |
$4,246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,950.40
|
| Rate for Payer: Healthscope Commercial |
$4,444.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,703.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,197.30
|
| Rate for Payer: Nomi Health Commercial |
$4,049.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,703.50
|
| Rate for Payer: PHP Commercial |
$4,197.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,296.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,436.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,345.44
|
| Rate for Payer: UHC Core |
$4,123.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,703.50
|
|
|
HC CLOSED RX INTER/PERI/SUB-TROCHANTERIC FEM FX W/O MANIP
|
Facility
|
OP
|
$4,938.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$870.57 |
| Max. Negotiated Rate |
$4,444.20 |
| Rate for Payer: Aetna Commercial |
$4,197.30
|
| Rate for Payer: Aetna Medicare |
$1,283.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,543.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,543.12
|
| Rate for Payer: BCBS Complete |
$914.02
|
| Rate for Payer: BCBS MAPPO |
$1,234.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,059.53
|
| Rate for Payer: BCN Commercial |
$4,059.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,234.50
|
| Rate for Payer: Cash Price |
$3,950.40
|
| Rate for Payer: Cofinity Commercial |
$4,246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,950.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,234.50
|
| Rate for Payer: Healthscope Commercial |
$4,444.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,703.50
|
| Rate for Payer: Mclaren Medicaid |
$870.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,296.22
|
| Rate for Payer: Meridian Medicaid |
$914.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,419.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,357.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,197.30
|
| Rate for Payer: Nomi Health Commercial |
$4,049.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,703.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,172.78
|
| Rate for Payer: PACE SWMI |
$1,234.50
|
| Rate for Payer: PHP Commercial |
$4,197.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,234.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$870.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,296.06
|
| Rate for Payer: Priority Health Medicare |
$1,246.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,436.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,234.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,345.44
|
| Rate for Payer: UHC Core |
$4,123.23
|
| Rate for Payer: UHC Exchange |
$1,234.50
|
| Rate for Payer: UHC Medicaid |
$870.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,234.50
|
| Rate for Payer: UHCCP Medicaid |
$870.57
|
| Rate for Payer: VA VA |
$1,234.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,703.50
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.26 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: BCBS Trust/PPO |
$355.11
|
| Rate for Payer: BCN Commercial |
$355.11
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$111.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.37
|
| Rate for Payer: BCBS Complete |
$79.59
|
| Rate for Payer: BCBS MAPPO |
$107.49
|
| Rate for Payer: BCBS Trust/PPO |
$353.48
|
| Rate for Payer: BCN Commercial |
$353.48
|
| Rate for Payer: BCN Medicare Advantage |
$107.49
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.49
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$75.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.87
|
| Rate for Payer: Meridian Medicaid |
$79.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Senior Care Partners |
$102.12
|
| Rate for Payer: PACE SWMI |
$107.49
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: PHP Medicare Advantage |
$107.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Medicare |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$107.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: UHC Exchange |
$107.49
|
| Rate for Payer: UHC Medicaid |
$75.80
|
| Rate for Payer: UHC Medicare Advantage |
$107.49
|
| Rate for Payer: UHCCP Medicaid |
$75.80
|
| Rate for Payer: VA VA |
$107.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX NAVICULAR FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX NAVICULAR FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX PATELLA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
76100171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX PATELLA FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
76100171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX POST HIP ARTHRPLAS DISLOC
|
Facility
|
IP
|
$647.81
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.88 |
| Max. Negotiated Rate |
$583.03 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: BCBS Trust/PPO |
$535.03
|
| Rate for Payer: BCN Commercial |
$535.03
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Nomi Health Commercial |
$531.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$563.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.07
|
| Rate for Payer: UHC Core |
$540.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.86
|
|
|
HC CLOSED RX POST HIP ARTHRPLAS DISLOC
|
Facility
|
OP
|
$647.81
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.21 |
| Max. Negotiated Rate |
$583.03 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: Aetna Medicare |
$168.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.44
|
| Rate for Payer: BCBS Complete |
$119.91
|
| Rate for Payer: BCBS MAPPO |
$161.95
|
| Rate for Payer: BCBS Trust/PPO |
$532.56
|
| Rate for Payer: BCN Commercial |
$532.56
|
| Rate for Payer: BCN Medicare Advantage |
$161.95
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.95
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.86
|
| Rate for Payer: Mclaren Medicaid |
$114.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.05
|
| Rate for Payer: Meridian Medicaid |
$119.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Nomi Health Commercial |
$531.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PACE Senior Care Partners |
$153.85
|
| Rate for Payer: PACE SWMI |
$161.95
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: PHP Medicare Advantage |
$161.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$563.59
|
| Rate for Payer: Priority Health Medicare |
$163.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.88
|
| Rate for Payer: Railroad Medicare Medicare |
$161.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.07
|
| Rate for Payer: UHC Core |
$540.92
|
| Rate for Payer: UHC Exchange |
$161.95
|
| Rate for Payer: UHC Medicaid |
$114.21
|
| Rate for Payer: UHC Medicare Advantage |
$161.95
|
| Rate for Payer: UHCCP Medicaid |
$114.21
|
| Rate for Payer: VA VA |
$161.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.86
|
|
|
HC CLOSED RX PROX HUMERUS FRACTURE
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX PROX HUMERUS FRACTURE
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX PROX THIGH FX
|
Facility
|
IP
|
$634.60
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
76100317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.68 |
| Max. Negotiated Rate |
$571.14 |
| Rate for Payer: Aetna Commercial |
$539.41
|
| Rate for Payer: BCBS Trust/PPO |
$524.12
|
| Rate for Payer: BCN Commercial |
$524.12
|
| Rate for Payer: Cash Price |
$507.68
|
| Rate for Payer: Cofinity Commercial |
$545.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.68
|
| Rate for Payer: Healthscope Commercial |
$571.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.41
|
| Rate for Payer: Nomi Health Commercial |
$520.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.95
|
| Rate for Payer: PHP Commercial |
$539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$552.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.45
|
| Rate for Payer: UHC Core |
$529.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.95
|
|
|
HC CLOSED RX PROX THIGH FX
|
Facility
|
OP
|
$634.60
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
76100317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$571.14 |
| Rate for Payer: Aetna Commercial |
$539.41
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.31
|
| Rate for Payer: BCBS Complete |
$117.46
|
| Rate for Payer: BCBS MAPPO |
$158.65
|
| Rate for Payer: BCBS Trust/PPO |
$521.70
|
| Rate for Payer: BCN Commercial |
$521.70
|
| Rate for Payer: BCN Medicare Advantage |
$158.65
|
| Rate for Payer: Cash Price |
$507.68
|
| Rate for Payer: Cofinity Commercial |
$545.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.65
|
| Rate for Payer: Healthscope Commercial |
$571.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.95
|
| Rate for Payer: Mclaren Medicaid |
$111.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.58
|
| Rate for Payer: Meridian Medicaid |
$117.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$174.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.41
|
| Rate for Payer: Nomi Health Commercial |
$520.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.95
|
| Rate for Payer: PACE Senior Care Partners |
$150.72
|
| Rate for Payer: PACE SWMI |
$158.65
|
| Rate for Payer: PHP Commercial |
$539.41
|
| Rate for Payer: PHP Medicare Advantage |
$158.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$552.10
|
| Rate for Payer: Priority Health Medicare |
$160.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.68
|
| Rate for Payer: Railroad Medicare Medicare |
$158.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.45
|
| Rate for Payer: UHC Core |
$529.89
|
| Rate for Payer: UHC Exchange |
$158.65
|
| Rate for Payer: UHC Medicaid |
$111.88
|
| Rate for Payer: UHC Medicare Advantage |
$158.65
|
| Rate for Payer: UHCCP Medicaid |
$111.88
|
| Rate for Payer: VA VA |
$158.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.95
|
|
|
HC CLOSED RX RADIAL HEAD/NECK FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
76100161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX RADIAL HEAD/NECK FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
76100161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX RAD/ULNA SHAFT FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
76100162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX RAD/ULNA SHAFT FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
76100162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
