|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
IP
|
$590.39
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.08 |
| Max. Negotiated Rate |
$531.35 |
| Rate for Payer: Aetna Commercial |
$501.83
|
| Rate for Payer: BCBS Trust/PPO |
$456.25
|
| Rate for Payer: BCN Commercial |
$456.25
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$507.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.31
|
| Rate for Payer: Healthscope Commercial |
$531.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: PHP Commercial |
$501.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.54
|
| Rate for Payer: UHC Core |
$492.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.79
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,199.20
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,341.29 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.54
|
| Rate for Payer: BCN Commercial |
$1,699.54
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,649.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,341.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,935.30
|
| Rate for Payer: UHC Core |
$1,836.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,649.40
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
OP
|
$2,199.20
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: Aetna Medicare |
$571.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$687.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$687.25
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$549.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.88
|
| Rate for Payer: BCN Commercial |
$1,709.88
|
| Rate for Payer: BCN Medicare Advantage |
$549.80
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.80
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,649.40
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$577.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$632.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PACE Senior Care Partners |
$522.31
|
| Rate for Payer: PACE SWMI |
$549.80
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: PHP Medicare Advantage |
$549.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.30
|
| Rate for Payer: Priority Health Medicare |
$549.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,341.29
|
| Rate for Payer: Railroad Medicare Medicare |
$549.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,935.30
|
| Rate for Payer: UHC Core |
$1,836.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$549.80
|
| Rate for Payer: UHC Medicare Advantage |
$566.29
|
| Rate for Payer: VA VA |
$549.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,649.40
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$314.06
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$282.65 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: Aetna Medicare |
$81.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.14
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$78.52
|
| Rate for Payer: BCBS Trust/PPO |
$244.18
|
| Rate for Payer: BCN Commercial |
$244.18
|
| Rate for Payer: BCN Medicare Advantage |
$78.52
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cofinity Commercial |
$270.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.52
|
| Rate for Payer: Healthscope Commercial |
$282.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.54
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.95
|
| Rate for Payer: PACE Senior Care Partners |
$74.59
|
| Rate for Payer: PACE SWMI |
$78.52
|
| Rate for Payer: PHP Commercial |
$266.95
|
| Rate for Payer: PHP Medicare Advantage |
$78.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.23
|
| Rate for Payer: Priority Health Medicare |
$78.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.55
|
| Rate for Payer: Railroad Medicare Medicare |
$78.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.37
|
| Rate for Payer: UHC Core |
$262.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.52
|
| Rate for Payer: UHC Medicare Advantage |
$80.87
|
| Rate for Payer: VA VA |
$78.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.54
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$314.06
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.55 |
| Max. Negotiated Rate |
$282.65 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: BCBS Trust/PPO |
$242.71
|
| Rate for Payer: BCN Commercial |
$242.71
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cofinity Commercial |
$270.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.25
|
| Rate for Payer: Healthscope Commercial |
$282.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.95
|
| Rate for Payer: PHP Commercial |
$266.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.37
|
| Rate for Payer: UHC Core |
$262.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.54
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,147.16
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,697.45 |
| Max. Negotiated Rate |
$6,432.44 |
| Rate for Payer: Aetna Commercial |
$6,075.09
|
| Rate for Payer: Aetna Medicare |
$1,858.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,233.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,233.49
|
| Rate for Payer: BCBS Complete |
$3,785.15
|
| Rate for Payer: BCBS MAPPO |
$1,786.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,556.92
|
| Rate for Payer: BCN Commercial |
$5,556.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,786.79
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cofinity Commercial |
$6,146.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,717.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,786.79
|
| Rate for Payer: Healthscope Commercial |
$6,432.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,360.37
|
| Rate for Payer: Mclaren Medicaid |
$3,604.90
|
| Rate for Payer: Meridian Medicaid |
$3,785.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,876.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,054.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.09
|
| Rate for Payer: PACE Senior Care Partners |
$1,697.45
|
| Rate for Payer: PACE SWMI |
$1,786.79
|
| Rate for Payer: PHP Commercial |
$6,075.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,786.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,604.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,218.03
|
| Rate for Payer: Priority Health Medicare |
$1,786.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,359.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,786.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,289.50
|
| Rate for Payer: UHC Core |
$5,967.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,786.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,840.39
|
| Rate for Payer: VA VA |
$1,786.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,360.37
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,147.16
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,359.05 |
| Max. Negotiated Rate |
$6,432.44 |
| Rate for Payer: Aetna Commercial |
$6,075.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,523.33
|
| Rate for Payer: BCN Commercial |
$5,523.33
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cofinity Commercial |
$6,146.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,717.73
|
| Rate for Payer: Healthscope Commercial |
$6,432.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,360.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.09
|
| Rate for Payer: PHP Commercial |
$6,075.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,218.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,359.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,289.50
|
| Rate for Payer: UHC Core |
$5,967.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,360.37
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$314.79
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$191.99 |
| Max. Negotiated Rate |
$283.31 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: BCBS Trust/PPO |
$243.27
|
| Rate for Payer: BCN Commercial |
$243.27
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cofinity Commercial |
$270.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.83
|
| Rate for Payer: Healthscope Commercial |
$283.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.57
|
| Rate for Payer: PHP Commercial |
$267.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.02
|
| Rate for Payer: UHC Core |
$262.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.09
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$314.79
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$283.31 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Aetna Medicare |
$81.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.37
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$78.70
|
| Rate for Payer: BCBS Trust/PPO |
$244.75
|
| Rate for Payer: BCN Commercial |
$244.75
|
| Rate for Payer: BCN Medicare Advantage |
$78.70
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cofinity Commercial |
$270.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.70
|
| Rate for Payer: Healthscope Commercial |
$283.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.09
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.57
|
| Rate for Payer: PACE Senior Care Partners |
$74.76
|
| Rate for Payer: PACE SWMI |
$78.70
|
| Rate for Payer: PHP Commercial |
$267.57
|
| Rate for Payer: PHP Medicare Advantage |
$78.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.87
|
| Rate for Payer: Priority Health Medicare |
$78.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.99
|
| Rate for Payer: Railroad Medicare Medicare |
$78.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.02
|
| Rate for Payer: UHC Core |
$262.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.70
|
| Rate for Payer: UHC Medicare Advantage |
$81.06
|
| Rate for Payer: VA VA |
$78.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.09
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$555.21
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$131.86 |
| Max. Negotiated Rate |
$499.69 |
| Rate for Payer: Aetna Commercial |
$471.93
|
| Rate for Payer: Aetna Medicare |
$144.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.50
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$138.80
|
| Rate for Payer: BCBS Trust/PPO |
$431.68
|
| Rate for Payer: BCN Commercial |
$431.68
|
| Rate for Payer: BCN Medicare Advantage |
$138.80
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cofinity Commercial |
$477.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.80
|
| Rate for Payer: Healthscope Commercial |
$499.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.41
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.93
|
| Rate for Payer: PACE Senior Care Partners |
$131.86
|
| Rate for Payer: PACE SWMI |
$138.80
|
| Rate for Payer: PHP Commercial |
$471.93
|
| Rate for Payer: PHP Medicare Advantage |
$138.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.03
|
| Rate for Payer: Priority Health Medicare |
$138.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.62
|
| Rate for Payer: Railroad Medicare Medicare |
$138.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.58
|
| Rate for Payer: UHC Core |
$463.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.80
|
| Rate for Payer: UHC Medicare Advantage |
$142.97
|
| Rate for Payer: VA VA |
$138.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.41
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$555.21
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$338.62 |
| Max. Negotiated Rate |
$499.69 |
| Rate for Payer: Aetna Commercial |
$471.93
|
| Rate for Payer: BCBS Trust/PPO |
$429.07
|
| Rate for Payer: BCN Commercial |
$429.07
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cofinity Commercial |
$477.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.17
|
| Rate for Payer: Healthscope Commercial |
$499.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.93
|
| Rate for Payer: PHP Commercial |
$471.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.58
|
| Rate for Payer: UHC Core |
$463.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.41
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,118.56
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,511.91 |
| Max. Negotiated Rate |
$3,706.70 |
| Rate for Payer: Aetna Commercial |
$3,500.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,182.82
|
| Rate for Payer: BCN Commercial |
$3,182.82
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cofinity Commercial |
$3,541.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,294.85
|
| Rate for Payer: Healthscope Commercial |
$3,706.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,088.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,500.78
|
| Rate for Payer: PHP Commercial |
$3,500.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,882.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,583.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,511.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,624.33
|
| Rate for Payer: UHC Core |
$3,439.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,088.92
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,118.56
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$978.16 |
| Max. Negotiated Rate |
$3,706.70 |
| Rate for Payer: Aetna Commercial |
$3,500.78
|
| Rate for Payer: Aetna Medicare |
$1,070.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,287.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,287.05
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,029.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,202.18
|
| Rate for Payer: BCN Commercial |
$3,202.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.64
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cofinity Commercial |
$3,541.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,294.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.64
|
| Rate for Payer: Healthscope Commercial |
$3,706.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,088.92
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,081.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,184.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,500.78
|
| Rate for Payer: PACE Senior Care Partners |
$978.16
|
| Rate for Payer: PACE SWMI |
$1,029.64
|
| Rate for Payer: PHP Commercial |
$3,500.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,882.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,583.15
|
| Rate for Payer: Priority Health Medicare |
$1,029.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,511.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,029.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,624.33
|
| Rate for Payer: UHC Core |
$3,439.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,060.53
|
| Rate for Payer: VA VA |
$1,029.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,088.92
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$137.49
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.99
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.99
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.12
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$137.49
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna Medicare |
$35.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.97
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$34.37
|
| Rate for Payer: BCBS Trust/PPO |
$106.90
|
| Rate for Payer: BCN Commercial |
$106.90
|
| Rate for Payer: BCN Medicare Advantage |
$34.37
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.37
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.12
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PACE Senior Care Partners |
$32.65
|
| Rate for Payer: PACE SWMI |
$34.37
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: PHP Medicare Advantage |
$34.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.62
|
| Rate for Payer: Priority Health Medicare |
$34.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.99
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.37
|
| Rate for Payer: UHC Medicare Advantage |
$35.40
|
| Rate for Payer: VA VA |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.12
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$137.49
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.99
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.99
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.12
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$137.49
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna Medicare |
$35.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.97
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$34.37
|
| Rate for Payer: BCBS Trust/PPO |
$106.90
|
| Rate for Payer: BCN Commercial |
$106.90
|
| Rate for Payer: BCN Medicare Advantage |
$34.37
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.37
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.12
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PACE Senior Care Partners |
$32.65
|
| Rate for Payer: PACE SWMI |
$34.37
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: PHP Medicare Advantage |
$34.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.62
|
| Rate for Payer: Priority Health Medicare |
$34.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.99
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.37
|
| Rate for Payer: UHC Medicare Advantage |
$35.40
|
| Rate for Payer: VA VA |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.12
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$389.19
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$92.43 |
| Max. Negotiated Rate |
$350.27 |
| Rate for Payer: Aetna Commercial |
$330.81
|
| Rate for Payer: Aetna Medicare |
$101.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.62
|
| Rate for Payer: BCBS Complete |
$108.53
|
| Rate for Payer: BCBS MAPPO |
$97.30
|
| Rate for Payer: BCBS Trust/PPO |
$302.60
|
| Rate for Payer: BCN Commercial |
$302.60
|
| Rate for Payer: BCN Medicare Advantage |
$97.30
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cofinity Commercial |
$334.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.30
|
| Rate for Payer: Healthscope Commercial |
$350.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.89
|
| Rate for Payer: Mclaren Medicaid |
$103.36
|
| Rate for Payer: Meridian Medicaid |
$108.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.81
|
| Rate for Payer: PACE Senior Care Partners |
$92.43
|
| Rate for Payer: PACE SWMI |
$97.30
|
| Rate for Payer: PHP Commercial |
$330.81
|
| Rate for Payer: PHP Medicare Advantage |
$97.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.60
|
| Rate for Payer: Priority Health Medicare |
$97.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.37
|
| Rate for Payer: Railroad Medicare Medicare |
$97.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.49
|
| Rate for Payer: UHC Core |
$324.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.30
|
| Rate for Payer: UHC Medicare Advantage |
$100.22
|
| Rate for Payer: VA VA |
$97.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.89
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$389.19
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$237.37 |
| Max. Negotiated Rate |
$350.27 |
| Rate for Payer: Aetna Commercial |
$330.81
|
| Rate for Payer: BCBS Trust/PPO |
$300.77
|
| Rate for Payer: BCN Commercial |
$300.77
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cofinity Commercial |
$334.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.35
|
| Rate for Payer: Healthscope Commercial |
$350.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.81
|
| Rate for Payer: PHP Commercial |
$330.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.49
|
| Rate for Payer: UHC Core |
$324.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.89
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: BCBS Trust/PPO |
$270.77
|
| Rate for Payer: BCN Commercial |
$270.77
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$83.21 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$91.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.49
|
| Rate for Payer: BCBS Complete |
$108.53
|
| Rate for Payer: BCBS MAPPO |
$87.59
|
| Rate for Payer: BCBS Trust/PPO |
$272.41
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: BCN Medicare Advantage |
$87.59
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.59
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Mclaren Medicaid |
$103.36
|
| Rate for Payer: Meridian Medicaid |
$108.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Senior Care Partners |
$83.21
|
| Rate for Payer: PACE SWMI |
$87.59
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: PHP Medicare Advantage |
$87.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Medicare |
$87.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: Railroad Medicare Medicare |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.59
|
| Rate for Payer: UHC Medicare Advantage |
$90.22
|
| Rate for Payer: VA VA |
$87.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$541.49
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna Commercial |
$460.27
|
| Rate for Payer: Aetna Medicare |
$140.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.22
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$135.37
|
| Rate for Payer: BCBS Trust/PPO |
$421.01
|
| Rate for Payer: BCN Commercial |
$421.01
|
| Rate for Payer: BCN Medicare Advantage |
$135.37
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cofinity Commercial |
$465.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.37
|
| Rate for Payer: Healthscope Commercial |
$487.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.12
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.27
|
| Rate for Payer: PACE Senior Care Partners |
$128.60
|
| Rate for Payer: PACE SWMI |
$135.37
|
| Rate for Payer: PHP Commercial |
$460.27
|
| Rate for Payer: PHP Medicare Advantage |
$135.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.10
|
| Rate for Payer: Priority Health Medicare |
$135.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.25
|
| Rate for Payer: Railroad Medicare Medicare |
$135.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.51
|
| Rate for Payer: UHC Core |
$452.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.37
|
| Rate for Payer: UHC Medicare Advantage |
$139.43
|
| Rate for Payer: VA VA |
$135.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.12
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$541.49
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$330.25 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna Commercial |
$460.27
|
| Rate for Payer: BCBS Trust/PPO |
$418.46
|
| Rate for Payer: BCN Commercial |
$418.46
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cofinity Commercial |
$465.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.19
|
| Rate for Payer: Healthscope Commercial |
$487.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.27
|
| Rate for Payer: PHP Commercial |
$460.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.51
|
| Rate for Payer: UHC Core |
$452.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.12
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.31
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$182.40
|
| Rate for Payer: BCN Commercial |
$182.40
|
| Rate for Payer: BCN Medicare Advantage |
$58.65
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.65
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.41
|
| Rate for Payer: PACE Senior Care Partners |
$55.72
|
| Rate for Payer: PACE SWMI |
$58.65
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: PHP Medicare Advantage |
$58.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.10
|
| Rate for Payer: Priority Health Medicare |
$58.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.08
|
| Rate for Payer: Railroad Medicare Medicare |
$58.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.45
|
| Rate for Payer: UHC Core |
$195.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.65
|
| Rate for Payer: UHC Medicare Advantage |
$60.41
|
| Rate for Payer: VA VA |
$58.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: BCBS Trust/PPO |
$181.30
|
| Rate for Payer: BCN Commercial |
$181.30
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.45
|
| Rate for Payer: UHC Core |
$195.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
