|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$405.85
|
| Rate for Payer: BCN Commercial |
$405.85
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$427.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$127.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.56
|
| Rate for Payer: BCBS Complete |
$90.96
|
| Rate for Payer: BCBS MAPPO |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$403.98
|
| Rate for Payer: BCN Commercial |
$403.98
|
| Rate for Payer: BCN Medicare Advantage |
$122.85
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.85
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Mclaren Medicaid |
$86.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.99
|
| Rate for Payer: Meridian Medicaid |
$90.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Senior Care Partners |
$116.71
|
| Rate for Payer: PACE SWMI |
$122.85
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$122.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$427.52
|
| Rate for Payer: Priority Health Medicare |
$124.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.01
|
| Rate for Payer: Railroad Medicare Medicare |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: UHC Exchange |
$122.85
|
| Rate for Payer: UHC Medicaid |
$86.63
|
| Rate for Payer: UHC Medicare Advantage |
$122.85
|
| Rate for Payer: UHCCP Medicaid |
$86.63
|
| Rate for Payer: VA VA |
$122.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
OP
|
$614.24
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.29 |
| Max. Negotiated Rate |
$552.82 |
| Rate for Payer: Aetna Commercial |
$522.10
|
| Rate for Payer: Aetna Medicare |
$159.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.95
|
| Rate for Payer: BCBS Complete |
$113.70
|
| Rate for Payer: BCBS MAPPO |
$153.56
|
| Rate for Payer: BCBS Trust/PPO |
$504.97
|
| Rate for Payer: BCN Commercial |
$504.97
|
| Rate for Payer: BCN Medicare Advantage |
$153.56
|
| Rate for Payer: Cash Price |
$491.39
|
| Rate for Payer: Cofinity Commercial |
$528.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.56
|
| Rate for Payer: Healthscope Commercial |
$552.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.68
|
| Rate for Payer: Mclaren Medicaid |
$108.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.24
|
| Rate for Payer: Meridian Medicaid |
$113.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.10
|
| Rate for Payer: Nomi Health Commercial |
$503.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.68
|
| Rate for Payer: PACE Senior Care Partners |
$145.88
|
| Rate for Payer: PACE SWMI |
$153.56
|
| Rate for Payer: PHP Commercial |
$522.10
|
| Rate for Payer: PHP Medicare Advantage |
$153.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$534.39
|
| Rate for Payer: Priority Health Medicare |
$155.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.51
|
| Rate for Payer: Railroad Medicare Medicare |
$153.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.53
|
| Rate for Payer: UHC Core |
$512.89
|
| Rate for Payer: UHC Exchange |
$153.56
|
| Rate for Payer: UHC Medicaid |
$108.29
|
| Rate for Payer: UHC Medicare Advantage |
$153.56
|
| Rate for Payer: UHCCP Medicaid |
$108.29
|
| Rate for Payer: VA VA |
$153.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.68
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
IP
|
$614.24
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$427.51 |
| Max. Negotiated Rate |
$552.82 |
| Rate for Payer: Aetna Commercial |
$522.10
|
| Rate for Payer: BCBS Trust/PPO |
$507.30
|
| Rate for Payer: BCN Commercial |
$507.30
|
| Rate for Payer: Cash Price |
$491.39
|
| Rate for Payer: Cofinity Commercial |
$528.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.39
|
| Rate for Payer: Healthscope Commercial |
$552.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.10
|
| Rate for Payer: Nomi Health Commercial |
$503.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.68
|
| Rate for Payer: PHP Commercial |
$522.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$534.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.53
|
| Rate for Payer: UHC Core |
$512.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.68
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,592.48 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.69
|
| Rate for Payer: BCN Commercial |
$1,889.69
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,592.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$403.38 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna Medicare |
$594.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.01
|
| Rate for Payer: BCBS Complete |
$423.52
|
| Rate for Payer: BCBS MAPPO |
$572.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.00
|
| Rate for Payer: BCN Commercial |
$1,881.00
|
| Rate for Payer: BCN Medicare Advantage |
$572.01
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.01
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,716.03
|
| Rate for Payer: Mclaren Medicaid |
$403.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.61
|
| Rate for Payer: Meridian Medicaid |
$423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$629.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,876.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PACE Senior Care Partners |
$543.41
|
| Rate for Payer: PACE SWMI |
$572.01
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: PHP Medicare Advantage |
$572.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,990.59
|
| Rate for Payer: Priority Health Medicare |
$577.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,592.48
|
| Rate for Payer: Railroad Medicare Medicare |
$572.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.48
|
| Rate for Payer: UHC Core |
$1,910.51
|
| Rate for Payer: UHC Exchange |
$572.01
|
| Rate for Payer: UHC Medicaid |
$403.38
|
| Rate for Payer: UHC Medicare Advantage |
$572.01
|
| Rate for Payer: UHCCP Medicaid |
$403.38
|
| Rate for Payer: VA VA |
$572.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,716.03
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$326.75
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.61 |
| Max. Negotiated Rate |
$294.07 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: Aetna Medicare |
$84.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.11
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: BCBS MAPPO |
$81.69
|
| Rate for Payer: BCBS Trust/PPO |
$268.62
|
| Rate for Payer: BCN Commercial |
$268.62
|
| Rate for Payer: BCN Medicare Advantage |
$81.69
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cofinity Commercial |
$281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.69
|
| Rate for Payer: Healthscope Commercial |
$294.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.06
|
| Rate for Payer: Mclaren Medicaid |
$57.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.77
|
| Rate for Payer: Meridian Medicaid |
$60.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.74
|
| Rate for Payer: Nomi Health Commercial |
$267.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.06
|
| Rate for Payer: PACE Senior Care Partners |
$77.60
|
| Rate for Payer: PACE SWMI |
$81.69
|
| Rate for Payer: PHP Commercial |
$277.74
|
| Rate for Payer: PHP Medicare Advantage |
$81.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.27
|
| Rate for Payer: Priority Health Medicare |
$82.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.42
|
| Rate for Payer: Railroad Medicare Medicare |
$81.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.54
|
| Rate for Payer: UHC Core |
$272.84
|
| Rate for Payer: UHC Exchange |
$81.69
|
| Rate for Payer: UHC Medicaid |
$57.61
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: UHCCP Medicaid |
$57.61
|
| Rate for Payer: VA VA |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.06
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$326.75
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.42 |
| Max. Negotiated Rate |
$294.07 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: BCBS Trust/PPO |
$269.86
|
| Rate for Payer: BCN Commercial |
$269.86
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cofinity Commercial |
$281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.40
|
| Rate for Payer: Healthscope Commercial |
$294.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.74
|
| Rate for Payer: Nomi Health Commercial |
$267.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.06
|
| Rate for Payer: PHP Commercial |
$277.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.54
|
| Rate for Payer: UHC Core |
$272.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.06
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,435.90
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,310.95 |
| Max. Negotiated Rate |
$6,692.31 |
| Rate for Payer: Aetna Commercial |
$6,320.52
|
| Rate for Payer: Aetna Medicare |
$1,933.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.72
|
| Rate for Payer: BCBS Complete |
$1,376.39
|
| Rate for Payer: BCBS MAPPO |
$1,858.97
|
| Rate for Payer: BCBS Trust/PPO |
$6,113.05
|
| Rate for Payer: BCN Commercial |
$6,113.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.97
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$6,394.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,948.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.97
|
| Rate for Payer: Healthscope Commercial |
$6,692.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,576.93
|
| Rate for Payer: Mclaren Medicaid |
$1,310.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.92
|
| Rate for Payer: Meridian Medicaid |
$1,376.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,044.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,320.52
|
| Rate for Payer: Nomi Health Commercial |
$6,097.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,576.93
|
| Rate for Payer: PACE Senior Care Partners |
$1,766.03
|
| Rate for Payer: PACE SWMI |
$1,858.97
|
| Rate for Payer: PHP Commercial |
$6,320.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,310.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,469.23
|
| Rate for Payer: Priority Health Medicare |
$1,877.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,175.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,543.59
|
| Rate for Payer: UHC Core |
$6,208.98
|
| Rate for Payer: UHC Exchange |
$1,858.97
|
| Rate for Payer: UHC Medicaid |
$1,310.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.97
|
| Rate for Payer: UHCCP Medicaid |
$1,310.95
|
| Rate for Payer: VA VA |
$1,858.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,576.93
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,435.90
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,175.39 |
| Max. Negotiated Rate |
$6,692.31 |
| Rate for Payer: Aetna Commercial |
$6,320.52
|
| Rate for Payer: BCBS Trust/PPO |
$6,141.31
|
| Rate for Payer: BCN Commercial |
$6,141.31
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cofinity Commercial |
$6,394.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,948.72
|
| Rate for Payer: Healthscope Commercial |
$6,692.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,576.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,320.52
|
| Rate for Payer: Nomi Health Commercial |
$6,097.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,576.93
|
| Rate for Payer: PHP Commercial |
$6,320.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,469.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,175.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,543.59
|
| Rate for Payer: UHC Core |
$6,208.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,576.93
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$327.51
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$227.95 |
| Max. Negotiated Rate |
$294.76 |
| Rate for Payer: Aetna Commercial |
$278.38
|
| Rate for Payer: BCBS Trust/PPO |
$270.49
|
| Rate for Payer: BCN Commercial |
$270.49
|
| Rate for Payer: Cash Price |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$281.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.01
|
| Rate for Payer: Healthscope Commercial |
$294.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.38
|
| Rate for Payer: Nomi Health Commercial |
$268.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.63
|
| Rate for Payer: PHP Commercial |
$278.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.21
|
| Rate for Payer: UHC Core |
$273.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.63
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$327.51
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$294.76 |
| Rate for Payer: Aetna Commercial |
$278.38
|
| Rate for Payer: Aetna Medicare |
$85.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.35
|
| Rate for Payer: BCBS Complete |
$60.62
|
| Rate for Payer: BCBS MAPPO |
$81.88
|
| Rate for Payer: BCBS Trust/PPO |
$269.25
|
| Rate for Payer: BCN Commercial |
$269.25
|
| Rate for Payer: BCN Medicare Advantage |
$81.88
|
| Rate for Payer: Cash Price |
$262.01
|
| Rate for Payer: Cofinity Commercial |
$281.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.88
|
| Rate for Payer: Healthscope Commercial |
$294.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.63
|
| Rate for Payer: Mclaren Medicaid |
$57.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.97
|
| Rate for Payer: Meridian Medicaid |
$60.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.38
|
| Rate for Payer: Nomi Health Commercial |
$268.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.63
|
| Rate for Payer: PACE Senior Care Partners |
$77.78
|
| Rate for Payer: PACE SWMI |
$81.88
|
| Rate for Payer: PHP Commercial |
$278.38
|
| Rate for Payer: PHP Medicare Advantage |
$81.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$284.93
|
| Rate for Payer: Priority Health Medicare |
$82.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.95
|
| Rate for Payer: Railroad Medicare Medicare |
$81.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.21
|
| Rate for Payer: UHC Core |
$273.47
|
| Rate for Payer: UHC Exchange |
$81.88
|
| Rate for Payer: UHC Medicaid |
$57.74
|
| Rate for Payer: UHC Medicare Advantage |
$81.88
|
| Rate for Payer: UHCCP Medicaid |
$57.74
|
| Rate for Payer: VA VA |
$81.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.63
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$577.64
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$519.88 |
| Rate for Payer: Aetna Commercial |
$490.99
|
| Rate for Payer: Aetna Medicare |
$150.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.51
|
| Rate for Payer: BCBS Complete |
$106.92
|
| Rate for Payer: BCBS MAPPO |
$144.41
|
| Rate for Payer: BCBS Trust/PPO |
$474.88
|
| Rate for Payer: BCN Commercial |
$474.88
|
| Rate for Payer: BCN Medicare Advantage |
$144.41
|
| Rate for Payer: Cash Price |
$462.11
|
| Rate for Payer: Cofinity Commercial |
$496.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.41
|
| Rate for Payer: Healthscope Commercial |
$519.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.23
|
| Rate for Payer: Mclaren Medicaid |
$101.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.63
|
| Rate for Payer: Meridian Medicaid |
$106.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$158.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.99
|
| Rate for Payer: Nomi Health Commercial |
$473.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.23
|
| Rate for Payer: PACE Senior Care Partners |
$137.19
|
| Rate for Payer: PACE SWMI |
$144.41
|
| Rate for Payer: PHP Commercial |
$490.99
|
| Rate for Payer: PHP Medicare Advantage |
$144.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$502.55
|
| Rate for Payer: Priority Health Medicare |
$145.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.04
|
| Rate for Payer: Railroad Medicare Medicare |
$144.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.32
|
| Rate for Payer: UHC Core |
$482.33
|
| Rate for Payer: UHC Exchange |
$144.41
|
| Rate for Payer: UHC Medicaid |
$101.84
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: UHCCP Medicaid |
$101.84
|
| Rate for Payer: VA VA |
$144.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.23
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$577.64
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$402.04 |
| Max. Negotiated Rate |
$519.88 |
| Rate for Payer: Aetna Commercial |
$490.99
|
| Rate for Payer: BCBS Trust/PPO |
$477.07
|
| Rate for Payer: BCN Commercial |
$477.07
|
| Rate for Payer: Cash Price |
$462.11
|
| Rate for Payer: Cofinity Commercial |
$496.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.11
|
| Rate for Payer: Healthscope Commercial |
$519.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.99
|
| Rate for Payer: Nomi Health Commercial |
$473.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.23
|
| Rate for Payer: PHP Commercial |
$490.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$502.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$402.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.32
|
| Rate for Payer: UHC Core |
$482.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.23
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,284.95
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$755.44 |
| Max. Negotiated Rate |
$3,856.45 |
| Rate for Payer: Aetna Commercial |
$3,642.21
|
| Rate for Payer: Aetna Medicare |
$1,114.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,339.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,339.05
|
| Rate for Payer: BCBS Complete |
$793.14
|
| Rate for Payer: BCBS MAPPO |
$1,071.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,522.66
|
| Rate for Payer: BCN Commercial |
$3,522.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.24
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cofinity Commercial |
$3,685.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,427.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.24
|
| Rate for Payer: Healthscope Commercial |
$3,856.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,213.71
|
| Rate for Payer: Mclaren Medicaid |
$755.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.80
|
| Rate for Payer: Meridian Medicaid |
$793.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,231.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,178.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.21
|
| Rate for Payer: Nomi Health Commercial |
$3,513.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,213.71
|
| Rate for Payer: PACE Senior Care Partners |
$1,017.68
|
| Rate for Payer: PACE SWMI |
$1,071.24
|
| Rate for Payer: PHP Commercial |
$3,642.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,727.91
|
| Rate for Payer: Priority Health Medicare |
$1,081.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,982.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,071.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,770.76
|
| Rate for Payer: UHC Core |
$3,577.93
|
| Rate for Payer: UHC Exchange |
$1,071.24
|
| Rate for Payer: UHC Medicaid |
$755.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.24
|
| Rate for Payer: UHCCP Medicaid |
$755.44
|
| Rate for Payer: VA VA |
$1,071.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,213.71
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,284.95
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,982.33 |
| Max. Negotiated Rate |
$3,856.45 |
| Rate for Payer: Aetna Commercial |
$3,642.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,538.94
|
| Rate for Payer: BCN Commercial |
$3,538.94
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cofinity Commercial |
$3,685.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,427.96
|
| Rate for Payer: Healthscope Commercial |
$3,856.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,213.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.21
|
| Rate for Payer: Nomi Health Commercial |
$3,513.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,213.71
|
| Rate for Payer: PHP Commercial |
$3,642.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,727.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,982.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,770.76
|
| Rate for Payer: UHC Core |
$3,577.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,213.71
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: BCBS Trust/PPO |
$118.14
|
| Rate for Payer: BCN Commercial |
$118.14
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.88
|
| Rate for Payer: UHC Core |
$119.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.28
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.70
|
| Rate for Payer: BCBS Complete |
$26.48
|
| Rate for Payer: BCBS MAPPO |
$35.76
|
| Rate for Payer: BCBS Trust/PPO |
$117.59
|
| Rate for Payer: BCN Commercial |
$117.59
|
| Rate for Payer: BCN Medicare Advantage |
$35.76
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.28
|
| Rate for Payer: Mclaren Medicaid |
$25.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.55
|
| Rate for Payer: Meridian Medicaid |
$26.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Senior Care Partners |
$33.97
|
| Rate for Payer: PACE SWMI |
$35.76
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: PHP Medicare Advantage |
$35.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.44
|
| Rate for Payer: Priority Health Medicare |
$36.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.56
|
| Rate for Payer: Railroad Medicare Medicare |
$35.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.88
|
| Rate for Payer: UHC Core |
$119.44
|
| Rate for Payer: UHC Exchange |
$35.76
|
| Rate for Payer: UHC Medicaid |
$25.22
|
| Rate for Payer: UHC Medicare Advantage |
$35.76
|
| Rate for Payer: UHCCP Medicaid |
$25.22
|
| Rate for Payer: VA VA |
$35.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.28
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.70
|
| Rate for Payer: BCBS Complete |
$26.48
|
| Rate for Payer: BCBS MAPPO |
$35.76
|
| Rate for Payer: BCBS Trust/PPO |
$117.59
|
| Rate for Payer: BCN Commercial |
$117.59
|
| Rate for Payer: BCN Medicare Advantage |
$35.76
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.28
|
| Rate for Payer: Mclaren Medicaid |
$25.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.55
|
| Rate for Payer: Meridian Medicaid |
$26.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Senior Care Partners |
$33.97
|
| Rate for Payer: PACE SWMI |
$35.76
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: PHP Medicare Advantage |
$35.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.44
|
| Rate for Payer: Priority Health Medicare |
$36.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.56
|
| Rate for Payer: Railroad Medicare Medicare |
$35.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.88
|
| Rate for Payer: UHC Core |
$119.44
|
| Rate for Payer: UHC Exchange |
$35.76
|
| Rate for Payer: UHC Medicaid |
$25.22
|
| Rate for Payer: UHC Medicare Advantage |
$35.76
|
| Rate for Payer: UHCCP Medicaid |
$25.22
|
| Rate for Payer: VA VA |
$35.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.28
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: BCBS Trust/PPO |
$118.14
|
| Rate for Payer: BCN Commercial |
$118.14
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.88
|
| Rate for Payer: UHC Core |
$119.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.28
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$281.82 |
| Max. Negotiated Rate |
$364.42 |
| Rate for Payer: Aetna Commercial |
$344.17
|
| Rate for Payer: BCBS Trust/PPO |
$334.42
|
| Rate for Payer: BCN Commercial |
$334.42
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Commercial |
$348.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Healthscope Commercial |
$364.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.17
|
| Rate for Payer: Nomi Health Commercial |
$332.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: PHP Commercial |
$344.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.32
|
| Rate for Payer: UHC Core |
$338.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.68
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$364.42 |
| Rate for Payer: Aetna Commercial |
$344.17
|
| Rate for Payer: Aetna Medicare |
$105.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$74.95
|
| Rate for Payer: BCBS MAPPO |
$101.23
|
| Rate for Payer: BCBS Trust/PPO |
$332.88
|
| Rate for Payer: BCN Commercial |
$332.88
|
| Rate for Payer: BCN Medicare Advantage |
$101.23
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Commercial |
$348.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.23
|
| Rate for Payer: Healthscope Commercial |
$364.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.68
|
| Rate for Payer: Mclaren Medicaid |
$71.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.29
|
| Rate for Payer: Meridian Medicaid |
$74.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.17
|
| Rate for Payer: Nomi Health Commercial |
$332.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: PACE Senior Care Partners |
$96.17
|
| Rate for Payer: PACE SWMI |
$101.23
|
| Rate for Payer: PHP Commercial |
$344.17
|
| Rate for Payer: PHP Medicare Advantage |
$101.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.27
|
| Rate for Payer: Priority Health Medicare |
$102.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.82
|
| Rate for Payer: Railroad Medicare Medicare |
$101.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.32
|
| Rate for Payer: UHC Core |
$338.10
|
| Rate for Payer: UHC Exchange |
$101.23
|
| Rate for Payer: UHC Medicaid |
$71.39
|
| Rate for Payer: UHC Medicare Advantage |
$101.23
|
| Rate for Payer: UHCCP Medicaid |
$71.39
|
| Rate for Payer: VA VA |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.68
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$253.71 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: BCBS Trust/PPO |
$301.07
|
| Rate for Payer: BCN Commercial |
$301.07
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.92
|
| Rate for Payer: BCBS Complete |
$67.47
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.68
|
| Rate for Payer: BCN Commercial |
$299.68
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: Meridian Medicaid |
$67.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Senior Care Partners |
$86.58
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Medicare |
$92.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: UHC Exchange |
$91.13
|
| Rate for Payer: UHC Medicaid |
$64.27
|
| Rate for Payer: UHC Medicare Advantage |
$91.13
|
| Rate for Payer: UHCCP Medicaid |
$64.27
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$563.37
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$392.11 |
| Max. Negotiated Rate |
$507.03 |
| Rate for Payer: Aetna Commercial |
$478.86
|
| Rate for Payer: BCBS Trust/PPO |
$465.29
|
| Rate for Payer: BCN Commercial |
$465.29
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cofinity Commercial |
$484.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.70
|
| Rate for Payer: Healthscope Commercial |
$507.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$461.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.53
|
| Rate for Payer: PHP Commercial |
$478.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$490.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.77
|
| Rate for Payer: UHC Core |
$470.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.53
|
|
