|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$91.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.78
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$87.82
|
| Rate for Payer: BCBS Trust/PPO |
$288.79
|
| Rate for Payer: BCN Commercial |
$273.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.82
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.21
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.43
|
| Rate for Payer: PACE SWMI |
$87.82
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$87.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO |
$305.61
|
| Rate for Payer: Priority Health Medicare |
$88.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.36
|
| Rate for Payer: Railroad Medicare Medicare |
$87.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.13
|
| Rate for Payer: UHC Core |
$293.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.82
|
| Rate for Payer: UHC Exchange |
$87.82
|
| Rate for Payer: UHC Medicare Advantage |
$87.82
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$87.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
IP
|
$2,115.23
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
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 ULNAR FX PROX END
|
Facility
|
OP
|
$2,115.23
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
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 |
$1,190.46
|
| 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 |
$1,133.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.25
|
| Rate for Payer: Meridian Medicaid |
$1,190.46
|
| 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 |
$1,133.70
|
| 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 |
$1,133.70
|
| Rate for Payer: VA VA |
$528.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,586.42
|
|
|
HC CLOSED TX ULNAR FX, PROX END W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
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 |
$178.43
|
| 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 |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| 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 |
$169.93
|
| 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 |
$169.93
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX ULNAR FX, PROX END W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
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 ULNAR SHAFT FX, W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
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 |
$178.43
|
| 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 |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.34
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| 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 |
$169.93
|
| 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 |
$169.93
|
| Rate for Payer: VA VA |
$84.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
HC CLOSED TX ULNAR SHAFT FX, W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
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 ULNAR STYLOID FX
|
Facility
|
IP
|
$321.79
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
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 ULNAR STYLOID FX
|
Facility
|
OP
|
$321.79
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
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 |
$178.43
|
| 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 |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.47
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| 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 |
$169.93
|
| 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 |
$169.93
|
| Rate for Payer: VA VA |
$80.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.34
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
OP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$385.78 |
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna Medicare |
$111.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.95
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$107.16
|
| Rate for Payer: BCBS Trust/PPO |
$352.38
|
| Rate for Payer: BCN Commercial |
$333.27
|
| Rate for Payer: BCN Medicare Advantage |
$107.16
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.48
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.52
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: Nomi Health Commercial |
$351.48
|
| Rate for Payer: PACE Senior Care Partners |
$101.80
|
| Rate for Payer: PACE SWMI |
$107.16
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: PHP Medicare Advantage |
$107.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health HMO/PPO |
$372.92
|
| Rate for Payer: Priority Health Medicare |
$108.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.19
|
| Rate for Payer: Railroad Medicare Medicare |
$107.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.20
|
| Rate for Payer: UHC Core |
$357.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.16
|
| Rate for Payer: UHC Exchange |
$107.16
|
| Rate for Payer: UHC Medicare Advantage |
$107.16
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$107.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.48
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
IP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.62 |
| Max. Negotiated Rate |
$385.78 |
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: BCBS Trust/PPO |
$349.90
|
| Rate for Payer: BCN Commercial |
$331.25
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: Nomi Health Commercial |
$351.48
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health HMO/PPO |
$372.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.20
|
| Rate for Payer: UHC Core |
$357.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.48
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
IP
|
$363.27
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.13 |
| Max. Negotiated Rate |
$326.94 |
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: BCBS Trust/PPO |
$296.54
|
| Rate for Payer: BCN Commercial |
$280.74
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$297.88
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health HMO/PPO |
$316.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.68
|
| Rate for Payer: UHC Core |
$303.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.45
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
OP
|
$363.27
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.28 |
| Max. Negotiated Rate |
$326.94 |
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: Aetna Medicare |
$94.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.52
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$90.82
|
| Rate for Payer: BCBS Trust/PPO |
$298.64
|
| Rate for Payer: BCN Commercial |
$282.44
|
| Rate for Payer: BCN Medicare Advantage |
$90.82
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.45
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.36
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$297.88
|
| Rate for Payer: PACE Senior Care Partners |
$86.28
|
| Rate for Payer: PACE SWMI |
$90.82
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: PHP Medicare Advantage |
$90.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health HMO/PPO |
$316.04
|
| Rate for Payer: Priority Health Medicare |
$91.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.39
|
| Rate for Payer: Railroad Medicare Medicare |
$90.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.68
|
| Rate for Payer: UHC Core |
$303.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.82
|
| Rate for Payer: UHC Exchange |
$90.82
|
| Rate for Payer: UHC Medicare Advantage |
$90.82
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$90.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.45
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$91.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.78
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$87.82
|
| Rate for Payer: BCBS Trust/PPO |
$288.79
|
| Rate for Payer: BCN Commercial |
$273.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.82
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.21
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.43
|
| Rate for Payer: PACE SWMI |
$87.82
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$87.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO |
$305.61
|
| Rate for Payer: Priority Health Medicare |
$88.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.36
|
| Rate for Payer: Railroad Medicare Medicare |
$87.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.13
|
| Rate for Payer: UHC Core |
$293.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.82
|
| Rate for Payer: UHC Exchange |
$87.82
|
| Rate for Payer: UHC Medicare Advantage |
$87.82
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$87.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
IP
|
$351.28
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.33 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: BCBS Trust/PPO |
$286.75
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO |
$305.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.13
|
| Rate for Payer: UHC Core |
$293.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$91.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.78
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$87.82
|
| Rate for Payer: BCBS Trust/PPO |
$288.79
|
| Rate for Payer: BCN Commercial |
$273.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.82
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.21
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.43
|
| Rate for Payer: PACE SWMI |
$87.82
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$87.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO |
$305.61
|
| Rate for Payer: Priority Health Medicare |
$88.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.36
|
| Rate for Payer: Railroad Medicare Medicare |
$87.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.13
|
| Rate for Payer: UHC Core |
$293.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.82
|
| Rate for Payer: UHC Exchange |
$87.82
|
| Rate for Payer: UHC Medicare Advantage |
$87.82
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$87.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
IP
|
$351.28
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.33 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: BCBS Trust/PPO |
$286.75
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO |
$305.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.13
|
| Rate for Payer: UHC Core |
$293.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,138.46
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.38 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$355.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$355.77
|
| Rate for Payer: BCBS Complete |
$455.38
|
| Rate for Payer: BCBS MAPPO |
$284.62
|
| Rate for Payer: BCBS Trust/PPO |
$935.93
|
| Rate for Payer: BCN Commercial |
$885.15
|
| Rate for Payer: BCN Medicare Advantage |
$284.62
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.62
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: Nomi Health Commercial |
$933.54
|
| Rate for Payer: PACE Senior Care Partners |
$270.38
|
| Rate for Payer: PACE SWMI |
$284.62
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: PHP Medicare Advantage |
$284.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health HMO/PPO |
$990.46
|
| Rate for Payer: Priority Health Medicare |
$287.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.77
|
| Rate for Payer: Railroad Medicare Medicare |
$284.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.84
|
| Rate for Payer: UHC Core |
$950.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.62
|
| Rate for Payer: UHC Exchange |
$284.62
|
| Rate for Payer: UHC Medicare Advantage |
$284.62
|
| Rate for Payer: VA VA |
$284.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.84
|
|
|
HC CLOSURE DEVICE
|
Facility
|
IP
|
$1,138.46
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.00 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: BCBS Trust/PPO |
$929.32
|
| Rate for Payer: BCN Commercial |
$879.80
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: Nomi Health Commercial |
$933.54
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health HMO/PPO |
$990.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.84
|
| Rate for Payer: UHC Core |
$950.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.84
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$11.70
|
| Rate for Payer: UHCCP Medicaid |
$14.57
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.25
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$503.13
|
| Rate for Payer: BCN Commercial |
$475.83
|
| Rate for Payer: BCN Medicare Advantage |
$153.00
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.00
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.65
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Senior Care Partners |
$145.35
|
| Rate for Payer: PACE SWMI |
$153.00
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$153.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO |
$532.44
|
| Rate for Payer: Priority Health Medicare |
$154.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.04
|
| Rate for Payer: Railroad Medicare Medicare |
$153.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.56
|
| Rate for Payer: UHC Core |
$511.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.00
|
| Rate for Payer: UHC Exchange |
$153.00
|
| Rate for Payer: UHC Medicare Advantage |
$153.00
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$153.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: BCBS Trust/PPO |
$499.58
|
| Rate for Payer: BCN Commercial |
$472.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO |
$532.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.56
|
| Rate for Payer: UHC Core |
$511.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
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 CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
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 |
$178.43
|
| 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 |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| 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 |
$169.93
|
| 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 |
$169.93
|
| Rate for Payer: VA VA |
$158.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.33
|
|
