|
HC CLOSED TX HUMERAL CONDYLAR FX, MED/LAT, W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.74 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$302.56
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.74 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.75
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$513.40
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$315.00
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX MED MALLEOLUS FX W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZ
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$4,162.38 |
| Rate for Payer: Aetna Commercial |
$2,507.50
|
| Rate for Payer: Aetna Medicare |
$1,411.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,696.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,696.21
|
| Rate for Payer: BCBS Complete |
$779.44
|
| Rate for Payer: BCBS MAPPO |
$1,356.97
|
| Rate for Payer: BCBS Trust/PPO |
$653.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,356.97
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cofinity Commercial |
$2,537.00
|
| Rate for Payer: Cofinity Commercial |
$2,065.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,356.97
|
| Rate for Payer: Healthscope Commercial |
$2,655.00
|
| Rate for Payer: Mclaren Medicaid |
$742.26
|
| Rate for Payer: Mclaren Medicare |
$1,356.97
|
| Rate for Payer: Meridian Medicaid |
$779.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,424.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,560.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,507.50
|
| Rate for Payer: PACE Medicare |
$1,289.12
|
| Rate for Payer: PACE SWMI |
$1,356.97
|
| Rate for Payer: PHP Commercial |
$2,507.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,356.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,162.38
|
| Rate for Payer: Priority Health Medicare |
$1,356.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,329.90
|
| Rate for Payer: Priority Health SBD |
$1,858.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,356.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,356.97
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,397.68
|
| Rate for Payer: VA VA |
$1,356.97
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZ
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,858.50 |
| Max. Negotiated Rate |
$2,655.00 |
| Rate for Payer: Aetna Commercial |
$2,507.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.50
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cofinity Commercial |
$2,065.00
|
| Rate for Payer: Cofinity Commercial |
$2,537.00
|
| Rate for Payer: Healthscope Commercial |
$2,655.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,507.50
|
| Rate for Payer: PHP Commercial |
$2,507.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.00
|
| Rate for Payer: Priority Health SBD |
$1,858.50
|
|
|
HC CLOSED TX POST MALLEOLUS FX W/O MANIP
|
Facility
|
IP
|
$315.48
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Aetna Commercial |
$268.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.06
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| Rate for Payer: Cofinity Commercial |
$271.31
|
| Rate for Payer: Healthscope Commercial |
$283.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.16
|
| Rate for Payer: PHP Commercial |
$268.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health SBD |
$198.75
|
|
|
HC CLOSED TX POST MALLEOLUS FX W/O MANIP
|
Facility
|
OP
|
$315.48
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Aetna Commercial |
$268.16
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$79.68
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| Rate for Payer: Cofinity Commercial |
$271.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$283.93
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.16
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$268.16
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.75
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$513.40
|
| Rate for Payer: Priority Health SBD |
$198.75
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health SBD |
$392.28
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.74 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.75
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$513.40
|
| Rate for Payer: Priority Health SBD |
$392.28
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$292.08
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX PROX/MID PHALANX FX W/MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$343.26 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$212.37
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$312.05
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX PROX/MID PHALANX FX W/MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/O MANIP
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
76100352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$79.68
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$392.28
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$265.56
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/O MANIP
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
76100352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$529.26
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.86
|
| Rate for Payer: Priority Health SBD |
$392.28
|
|
|
HC CLOSED TX SCAPULAR FX, W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX SCAPULAR FX, W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.74 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$249.51
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX SESAMOID FX
|
Facility
|
IP
|
$315.48
|
|
|
Service Code
|
CPT 28530
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Aetna Commercial |
$268.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.06
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| Rate for Payer: Cofinity Commercial |
$271.31
|
| Rate for Payer: Healthscope Commercial |
$283.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.16
|
| Rate for Payer: PHP Commercial |
$268.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health SBD |
$198.75
|
|
|
HC CLOSED TX SESAMOID FX
|
Facility
|
OP
|
$315.48
|
|
|
Service Code
|
CPT 28530
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.32 |
| Max. Negotiated Rate |
$283.93 |
| Rate for Payer: Aetna Commercial |
$268.16
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$55.32
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| Rate for Payer: Cofinity Commercial |
$271.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$283.93
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.16
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$268.16
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.84
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$198.75
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$103.47
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/O MANIP
|
Facility
|
IP
|
$358.02
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$322.22 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.71
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Cofinity Commercial |
$250.61
|
| Rate for Payer: Cofinity Commercial |
$307.90
|
| Rate for Payer: Healthscope Commercial |
$322.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.32
|
| Rate for Payer: PHP Commercial |
$304.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.61
|
| Rate for Payer: Priority Health SBD |
$225.55
|
|
|
HC CLOSED TX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/O MANIP
|
Facility
|
OP
|
$358.02
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$174.32
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Cash Price |
$286.42
|
| Rate for Payer: Cofinity Commercial |
$307.90
|
| Rate for Payer: Cofinity Commercial |
$250.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$322.22
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.32
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$304.32
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$225.55
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$359.86
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.86 |
| Max. Negotiated Rate |
$296.94 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$207.86
|
|
|
HC CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$280.44
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$109.36
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cash Price |
$263.94
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$230.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.94
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.44
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.44
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$499.35
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX TALUS FX; W/O MANIP
|
Facility
|
OP
|
$285.94
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$262.29 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$79.68
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cofinity Commercial |
$245.91
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$257.35
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.05
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$243.05
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.16
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$180.14
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$214.47
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX TALUS FX; W/O MANIP
|
Facility
|
IP
|
$285.94
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.14 |
| Max. Negotiated Rate |
$257.35 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.86
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Cofinity Commercial |
$245.91
|
| Rate for Payer: Healthscope Commercial |
$257.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.05
|
| Rate for Payer: PHP Commercial |
$243.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.16
|
| Rate for Payer: Priority Health SBD |
$180.14
|
|
