|
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 |
$95.35 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$228.33
|
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$95.35
|
| Rate for Payer: BCN Commercial |
$95.35
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$116.47
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.97
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.46
|
|
|
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 |
$409.70 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna American Axle |
$1,374.90
|
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$795.35
|
| Rate for Payer: BCN Commercial |
$795.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$1,692.18
|
| 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: Cofinity Commercial |
$1,480.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,480.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,586.42
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,797.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$1,332.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.67
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$409.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: UMR Bronson Commercial |
$782.64
|
| Rate for Payer: VA VA |
$1,568.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,586.42
|
|
|
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 |
$930.70 |
| Max. Negotiated Rate |
$1,903.71 |
| Rate for Payer: Aetna American Axle |
$1,374.90
|
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.90
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,480.66
|
| Rate for Payer: Cofinity Commercial |
$1,819.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,480.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,480.66
|
| 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: PHP Commercial |
$1,797.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health SBD |
$1,332.59
|
| Rate for Payer: UMR Bronson Commercial |
$930.70
|
| 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 |
$124.52 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$218.74
|
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$168.20
|
| Rate for Payer: BCN Commercial |
$168.20
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.26
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$262.96
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$124.52
|
| Rate for Payer: VA VA |
$235.03
|
| 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 |
$148.07 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna American Axle |
$218.74
|
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: UMR Bronson Commercial |
$148.07
|
| 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 |
$148.07 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna American Axle |
$218.74
|
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: UMR Bronson Commercial |
$148.07
|
| 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 |
$124.52 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$218.74
|
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$142.96
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.40
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.26
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$238.42
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$124.52
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.40
|
|
|
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 |
$119.06 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$209.16
|
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$142.96
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Cofinity Commercial |
$225.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.34
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$202.73
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.65
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$300.59
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$119.06
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.34
|
|
|
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 |
$141.59 |
| Max. Negotiated Rate |
$289.61 |
| Rate for Payer: Aetna American Axle |
$209.16
|
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.16
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$225.25
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health SBD |
$202.73
|
| Rate for Payer: UMR Bronson Commercial |
$141.59
|
| 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
|
IP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$385.78 |
| Rate for Payer: Aetna American Axle |
$278.62
|
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health SBD |
$270.04
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
| 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
|
OP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$278.62
|
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$178.45
|
| Rate for Payer: BCN Commercial |
$178.45
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.48
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$270.04
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$288.11
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$158.60
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.48
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$236.13
|
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$197.17
|
| Rate for Payer: BCN Commercial |
$197.17
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Cofinity Commercial |
$254.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.45
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$228.86
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.95
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$187.23
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$134.41
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.45
|
|
|
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 |
$159.84 |
| Max. Negotiated Rate |
$326.94 |
| Rate for Payer: Aetna American Axle |
$236.13
|
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.13
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$254.29
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health SBD |
$228.86
|
| Rate for Payer: UMR Bronson Commercial |
$159.84
|
| 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 |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$228.33
|
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$142.96
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.04
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$216.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.97
|
| Rate for Payer: VA VA |
$235.03
|
| 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 |
$154.56 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna American Axle |
$228.33
|
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
| 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 |
$154.56 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna American Axle |
$228.33
|
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: UMR Bronson Commercial |
$154.56
|
| 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 |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$228.33
|
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$173.47
|
| Rate for Payer: BCN Commercial |
$173.47
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.46
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$186.22
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.97
|
| Rate for Payer: VA VA |
$235.03
|
| 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 |
$421.23 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna American Axle |
$740.00
|
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: Aetna Medicare |
$569.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.00
|
| Rate for Payer: BCBS Complete |
$455.38
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$796.92
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health SBD |
$717.23
|
| Rate for Payer: UMR Bronson Commercial |
$421.23
|
| 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 |
$500.92 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna American Axle |
$740.00
|
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.00
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$796.92
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health SBD |
$717.23
|
| Rate for Payer: UMR Bronson Commercial |
$500.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.84
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.19
|
| Rate for Payer: BCBS Complete |
$11.34
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$30.22
|
| Rate for Payer: PACE Medicare |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health Narrow Network |
$16.12
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Exchange |
$20.15
|
| Rate for Payer: UHC Medicare Advantage |
$20.15
|
| Rate for Payer: UHCCP Medicaid |
$10.80
|
| Rate for Payer: UMR Bronson Commercial |
$17.32
|
| Rate for Payer: VA VA |
$20.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
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 |
$269.28 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna American Axle |
$397.80
|
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: UMR Bronson Commercial |
$269.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$397.80
|
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$196.22
|
| Rate for Payer: BCN Commercial |
$196.22
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.33
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$328.48
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$226.44
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna American Axle |
$412.82
|
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$165.08
|
| Rate for Payer: BCN Commercial |
$165.08
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.33
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Priority Health SBD |
$400.12
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.66
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$260.60
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: UMR Bronson Commercial |
$234.99
|
| Rate for Payer: VA VA |
$235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.33
|
|
|
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 |
$279.45 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna American Axle |
$412.82
|
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health SBD |
$400.12
|
| Rate for Payer: UMR Bronson Commercial |
$279.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.33
|
|
