|
HC CLOSED TX DISTAL RADIAL FX/EPIPHYSEAL SEPARATION W/MANIP
|
Facility
|
OP
|
$2,115.23
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.37 |
| Max. Negotiated Rate |
$1,903.71 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Aetna Medicare |
$549.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$661.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$661.01
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$528.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.93
|
| Rate for Payer: BCN Commercial |
$1,644.59
|
| Rate for Payer: BCN Medicare Advantage |
$528.81
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,819.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.81
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,586.42
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.25
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$608.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: Nomi Health Commercial |
$1,734.49
|
| Rate for Payer: PACE Senior Care Partners |
$502.37
|
| Rate for Payer: PACE SWMI |
$528.81
|
| Rate for Payer: PHP Commercial |
$1,797.95
|
| Rate for Payer: PHP Medicare Advantage |
$528.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,840.25
|
| Rate for Payer: Priority Health Medicare |
$534.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,417.20
|
| Rate for Payer: Railroad Medicare Medicare |
$528.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,861.40
|
| Rate for Payer: UHC Core |
$1,766.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.81
|
| Rate for Payer: UHC Exchange |
$528.81
|
| Rate for Payer: UHC Medicare Advantage |
$528.81
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$528.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,586.42
|
|
|
HC CLOSED TX DISTAL RADIAL FX/EPIPHYSEAL SEPARATION W/MANIP
|
Facility
|
IP
|
$2,115.23
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$1,903.71 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.66
|
| Rate for Payer: BCN Commercial |
$1,634.65
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,819.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,586.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: Nomi Health Commercial |
$1,734.49
|
| Rate for Payer: PHP Commercial |
$1,797.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,840.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,417.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,861.40
|
| Rate for Payer: UHC Core |
$1,766.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,586.42
|
|
|
HC CLOSED TX FEMORAL FX, DISTAL END, MEDIAL/LAT CONDYLE W/O MANIP
|
Facility
|
OP
|
$365.18
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$328.66 |
| Rate for Payer: Aetna Commercial |
$310.40
|
| Rate for Payer: Aetna Medicare |
$94.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.12
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$91.30
|
| Rate for Payer: BCBS Trust/PPO |
$300.21
|
| Rate for Payer: BCN Commercial |
$283.93
|
| Rate for Payer: BCN Medicare Advantage |
$91.30
|
| Rate for Payer: Cash Price |
$292.14
|
| Rate for Payer: Cash Price |
$292.14
|
| Rate for Payer: Cofinity Commercial |
$314.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.30
|
| Rate for Payer: Healthscope Commercial |
$328.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.88
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.86
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.40
|
| Rate for Payer: Nomi Health Commercial |
$299.45
|
| Rate for Payer: PACE Senior Care Partners |
$86.73
|
| Rate for Payer: PACE SWMI |
$91.30
|
| Rate for Payer: PHP Commercial |
$310.40
|
| Rate for Payer: PHP Medicare Advantage |
$91.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.37
|
| Rate for Payer: Priority Health HMO/PPO |
$317.71
|
| Rate for Payer: Priority Health Medicare |
$92.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.67
|
| Rate for Payer: Railroad Medicare Medicare |
$91.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.36
|
| Rate for Payer: UHC Core |
$304.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.30
|
| Rate for Payer: UHC Exchange |
$91.30
|
| Rate for Payer: UHC Medicare Advantage |
$91.30
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.88
|
|
|
HC CLOSED TX FEMORAL FX, DISTAL END, MEDIAL/LAT CONDYLE W/O MANIP
|
Facility
|
IP
|
$365.18
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.37 |
| Max. Negotiated Rate |
$328.66 |
| Rate for Payer: Aetna Commercial |
$310.40
|
| Rate for Payer: BCBS Trust/PPO |
$298.10
|
| Rate for Payer: BCN Commercial |
$282.21
|
| Rate for Payer: Cash Price |
$292.14
|
| Rate for Payer: Cofinity Commercial |
$314.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.14
|
| Rate for Payer: Healthscope Commercial |
$328.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.40
|
| Rate for Payer: Nomi Health Commercial |
$299.45
|
| Rate for Payer: PHP Commercial |
$310.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.37
|
| Rate for Payer: Priority Health HMO/PPO |
$317.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.36
|
| Rate for Payer: UHC Core |
$304.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.88
|
|
|
HC CLOSED TX FRACTURE WB ARTICLR PRTN DSTL TIBIA WO MANIP
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.94 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: Aetna Medicare |
$172.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.81
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$166.25
|
| Rate for Payer: BCBS Trust/PPO |
$546.70
|
| Rate for Payer: BCN Commercial |
$517.04
|
| Rate for Payer: BCN Medicare Advantage |
$166.25
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$571.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.25
|
| Rate for Payer: Healthscope Commercial |
$598.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.75
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.56
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: Nomi Health Commercial |
$545.30
|
| Rate for Payer: PACE Senior Care Partners |
$157.94
|
| Rate for Payer: PACE SWMI |
$166.25
|
| Rate for Payer: PHP Commercial |
$565.25
|
| Rate for Payer: PHP Medicare Advantage |
$166.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health HMO/PPO |
$578.55
|
| Rate for Payer: Priority Health Medicare |
$167.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.55
|
| Rate for Payer: Railroad Medicare Medicare |
$166.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.20
|
| Rate for Payer: UHC Core |
$555.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.25
|
| Rate for Payer: UHC Exchange |
$166.25
|
| Rate for Payer: UHC Medicare Advantage |
$166.25
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$166.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.75
|
|
|
HC CLOSED TX FRACTURE WB ARTICLR PRTN DSTL TIBIA WO MANIP
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: BCBS Trust/PPO |
$542.84
|
| Rate for Payer: BCN Commercial |
$513.91
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$571.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Healthscope Commercial |
$598.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: Nomi Health Commercial |
$545.30
|
| Rate for Payer: PHP Commercial |
$565.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health HMO/PPO |
$578.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.20
|
| Rate for Payer: UHC Core |
$555.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.75
|
|
|
HC CLOSED TX GREAT TOE FX W/O MANIPULATION
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.17
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.13
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.13
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.13
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Senior Care Partners |
$79.93
|
| Rate for Payer: PACE SWMI |
$84.13
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Medicare |
$84.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: Railroad Medicare Medicare |
$84.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.13
|
| Rate for Payer: UHC Exchange |
$84.13
|
| Rate for Payer: UHC Medicare Advantage |
$84.13
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX GREAT TOE FX W/O MANIPULATION
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX GR TROCHANTERIC FX W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.17
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.13
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.13
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.13
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Senior Care Partners |
$79.93
|
| Rate for Payer: PACE SWMI |
$84.13
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Medicare |
$84.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: Railroad Medicare Medicare |
$84.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.13
|
| Rate for Payer: UHC Exchange |
$84.13
|
| Rate for Payer: UHC Medicare Advantage |
$84.13
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX GR TROCHANTERIC FX W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX HUMERAL CONDYLAR FX, MED/LAT, W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.17
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.13
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.13
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.13
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Senior Care Partners |
$79.93
|
| Rate for Payer: PACE SWMI |
$84.13
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Medicare |
$84.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: Railroad Medicare Medicare |
$84.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.13
|
| Rate for Payer: UHC Exchange |
$84.13
|
| Rate for Payer: UHC Medicare Advantage |
$84.13
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX HUMERAL CONDYLAR FX, MED/LAT, W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.17
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.13
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.13
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.13
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Senior Care Partners |
$79.93
|
| Rate for Payer: PACE SWMI |
$84.13
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Medicare |
$84.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: Railroad Medicare Medicare |
$84.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.13
|
| Rate for Payer: UHC Exchange |
$84.13
|
| Rate for Payer: UHC Medicare Advantage |
$84.13
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX INTERPHALANGEAL JT DISLOC W MANIP REQUIRE ANESTH
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: BCBS Trust/PPO |
$620.39
|
| Rate for Payer: BCN Commercial |
$587.33
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.00
|
| Rate for Payer: Nomi Health Commercial |
$623.20
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health HMO/PPO |
$661.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$509.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.80
|
| Rate for Payer: UHC Core |
$634.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC CLOSED TX INTERPHALANGEAL JT DISLOC W MANIP REQUIRE ANESTH
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.50 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna Medicare |
$197.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.50
|
| Rate for Payer: BCBS Complete |
$201.63
|
| Rate for Payer: BCBS MAPPO |
$190.00
|
| Rate for Payer: BCBS Trust/PPO |
$624.80
|
| Rate for Payer: BCN Commercial |
$590.90
|
| Rate for Payer: BCN Medicare Advantage |
$190.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Mclaren Medicaid |
$192.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.50
|
| Rate for Payer: Meridian Medicaid |
$201.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.00
|
| Rate for Payer: Nomi Health Commercial |
$623.20
|
| Rate for Payer: PACE Senior Care Partners |
$180.50
|
| Rate for Payer: PACE SWMI |
$190.00
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: PHP Medicare Advantage |
$190.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health HMO/PPO |
$661.20
|
| Rate for Payer: Priority Health Medicare |
$191.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$509.20
|
| Rate for Payer: Railroad Medicare Medicare |
$190.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.80
|
| Rate for Payer: UHC Core |
$634.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.00
|
| Rate for Payer: UHC Exchange |
$190.00
|
| Rate for Payer: UHC Medicare Advantage |
$190.00
|
| Rate for Payer: UHCCP Medicaid |
$192.01
|
| Rate for Payer: VA VA |
$190.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.17
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.13
|
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: BCN Commercial |
$261.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.13
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.13
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Senior Care Partners |
$79.93
|
| Rate for Payer: PACE SWMI |
$84.13
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Medicare |
$84.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: Railroad Medicare Medicare |
$84.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.13
|
| Rate for Payer: UHC Exchange |
$84.13
|
| Rate for Payer: UHC Medicare Advantage |
$84.13
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZ
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$714.64 |
| Max. Negotiated Rate |
$2,708.10 |
| Rate for Payer: Aetna Commercial |
$2,557.65
|
| Rate for Payer: Aetna Medicare |
$782.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$940.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$940.31
|
| Rate for Payer: BCBS Complete |
$1,124.59
|
| Rate for Payer: BCBS MAPPO |
$752.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,473.70
|
| Rate for Payer: BCN Commercial |
$2,339.50
|
| Rate for Payer: BCN Medicare Advantage |
$752.25
|
| Rate for Payer: Cash Price |
$2,407.20
|
| Rate for Payer: Cash Price |
$2,407.20
|
| Rate for Payer: Cofinity Commercial |
$2,587.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,407.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.25
|
| Rate for Payer: Healthscope Commercial |
$2,708.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,256.75
|
| Rate for Payer: Mclaren Medicaid |
$1,070.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.86
|
| Rate for Payer: Meridian Medicaid |
$1,124.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$865.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,557.65
|
| Rate for Payer: Nomi Health Commercial |
$2,467.38
|
| Rate for Payer: PACE Senior Care Partners |
$714.64
|
| Rate for Payer: PACE SWMI |
$752.25
|
| Rate for Payer: PHP Commercial |
$2,557.65
|
| Rate for Payer: PHP Medicare Advantage |
$752.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,955.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,617.83
|
| Rate for Payer: Priority Health Medicare |
$759.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,016.03
|
| Rate for Payer: Railroad Medicare Medicare |
$752.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,647.92
|
| Rate for Payer: UHC Core |
$2,512.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.25
|
| Rate for Payer: UHC Exchange |
$752.25
|
| Rate for Payer: UHC Medicare Advantage |
$752.25
|
| Rate for Payer: UHCCP Medicaid |
$1,070.97
|
| Rate for Payer: VA VA |
$752.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,256.75
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZ
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,955.85 |
| Max. Negotiated Rate |
$2,708.10 |
| Rate for Payer: Aetna Commercial |
$2,557.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,456.25
|
| Rate for Payer: BCN Commercial |
$2,325.36
|
| Rate for Payer: Cash Price |
$2,407.20
|
| Rate for Payer: Cofinity Commercial |
$2,587.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,407.20
|
| Rate for Payer: Healthscope Commercial |
$2,708.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,256.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,557.65
|
| Rate for Payer: Nomi Health Commercial |
$2,467.38
|
| Rate for Payer: PHP Commercial |
$2,557.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,955.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,617.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,016.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,647.92
|
| Rate for Payer: UHC Core |
$2,512.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,256.75
|
|
|
HC CLOSED TX POST MALLEOLUS FX W/O MANIP
|
Facility
|
IP
|
$321.79
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$289.61 |
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: BCBS Trust/PPO |
$262.68
|
| Rate for Payer: BCN Commercial |
$248.68
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: Nomi Health Commercial |
$263.87
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health HMO/PPO |
$279.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.18
|
| Rate for Payer: UHC Core |
$268.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.34
|
|
|
HC CLOSED TX POST MALLEOLUS FX W/O MANIP
|
Facility
|
OP
|
$321.79
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.43 |
| Max. Negotiated Rate |
$289.61 |
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: Aetna Medicare |
$83.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.56
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$80.45
|
| Rate for Payer: BCBS Trust/PPO |
$264.54
|
| Rate for Payer: BCN Commercial |
$250.19
|
| Rate for Payer: BCN Medicare Advantage |
$80.45
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.45
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.34
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.47
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: Nomi Health Commercial |
$263.87
|
| Rate for Payer: PACE Senior Care Partners |
$76.43
|
| Rate for Payer: PACE SWMI |
$80.45
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: PHP Medicare Advantage |
$80.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health HMO/PPO |
$279.96
|
| Rate for Payer: Priority Health Medicare |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.60
|
| Rate for Payer: Railroad Medicare Medicare |
$80.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.18
|
| Rate for Payer: UHC Core |
$268.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.45
|
| Rate for Payer: UHC Exchange |
$80.45
|
| Rate for Payer: UHC Medicare Advantage |
$80.45
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$80.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.34
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna Medicare |
$165.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.47
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$158.78
|
| Rate for Payer: BCBS Trust/PPO |
$522.12
|
| Rate for Payer: BCN Commercial |
$493.80
|
| Rate for Payer: BCN Medicare Advantage |
$158.78
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.78
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.33
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.72
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: PACE Senior Care Partners |
$150.84
|
| Rate for Payer: PACE SWMI |
$158.78
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: PHP Medicare Advantage |
$158.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health HMO/PPO |
$552.55
|
| Rate for Payer: Priority Health Medicare |
$160.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.52
|
| Rate for Payer: Railroad Medicare Medicare |
$158.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.90
|
| Rate for Payer: UHC Core |
$530.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.78
|
| Rate for Payer: UHC Exchange |
$158.78
|
| Rate for Payer: UHC Medicare Advantage |
$158.78
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$158.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.33
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.82 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: BCBS Trust/PPO |
$518.44
|
| Rate for Payer: BCN Commercial |
$490.81
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$520.79
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health HMO/PPO |
$552.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.90
|
| Rate for Payer: UHC Core |
$530.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.33
|
|
|
HC CLOSED TX PROX/MID PHALANX FX W/MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: BCBS Trust/PPO |
$274.71
|
| Rate for Payer: BCN Commercial |
$260.07
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO |
$292.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.15
|
| Rate for Payer: UHC Core |
$281.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
