|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
IP
|
$610.45
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.58 |
| Max. Negotiated Rate |
$549.40 |
| Rate for Payer: Aetna Commercial |
$518.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.79
|
| Rate for Payer: Cash Price |
$488.36
|
| Rate for Payer: Cofinity Commercial |
$427.32
|
| Rate for Payer: Cofinity Commercial |
$524.99
|
| Rate for Payer: Healthscope Commercial |
$549.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$518.88
|
| Rate for Payer: PHP Commercial |
$518.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.32
|
| Rate for Payer: Priority Health SBD |
$384.58
|
|
|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
OP
|
$610.45
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$549.40 |
| Rate for Payer: Aetna Commercial |
$518.88
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.79
|
| 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 |
$156.88
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$488.36
|
| Rate for Payer: Cash Price |
$488.36
|
| Rate for Payer: Cofinity Commercial |
$427.32
|
| Rate for Payer: Cofinity Commercial |
$524.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$549.40
|
| 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 |
$518.88
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$518.88
|
| 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 |
$427.32
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$384.58
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| 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 |
$53.14
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| 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 |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$292.73
|
| 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 |
$241.07
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$122.79
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.97 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health SBD |
$216.97
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
IP
|
$2,073.75
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.46 |
| Max. Negotiated Rate |
$1,866.38 |
| Rate for Payer: Aetna Commercial |
$1,762.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.94
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cofinity Commercial |
$1,451.62
|
| Rate for Payer: Cofinity Commercial |
$1,783.42
|
| Rate for Payer: Healthscope Commercial |
$1,866.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.69
|
| Rate for Payer: PHP Commercial |
$1,762.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.62
|
| Rate for Payer: Priority Health SBD |
$1,306.46
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
OP
|
$2,073.75
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$424.69 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Commercial |
$1,762.69
|
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$443.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cofinity Commercial |
$1,783.42
|
| Rate for Payer: Cofinity Commercial |
$1,451.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Healthscope Commercial |
$1,866.38
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.69
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Commercial |
$1,762.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,301.45
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,441.16
|
| Rate for Payer: Priority Health SBD |
$1,306.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$424.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
HC CLOSED TX ULNAR FX, PROX END W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
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 ULNAR FX, PROX END W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
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) |
$302.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$275.05
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX ULNAR SHAFT FX, W/O MANIP
|
Facility
|
IP
|
$329.93
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
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 ULNAR SHAFT FX, W/O MANIP
|
Facility
|
OP
|
$329.93
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| 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 |
$79.68
|
| 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 |
$230.95
|
| Rate for Payer: Cofinity Commercial |
$283.74
|
| 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) |
$275.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$250.49
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
OP
|
$315.48
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$345.06 |
| 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 |
$271.31
|
| Rate for Payer: Cofinity Commercial |
$220.84
|
| 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) |
$345.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$313.69
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
IP
|
$315.48
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
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 VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
OP
|
$420.24
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$641.75 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.16
|
| 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 |
$99.45
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$294.17
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| 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 |
$357.20
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$357.20
|
| 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 |
$294.17
|
| 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 |
$264.75
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$297.97
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
IP
|
$420.24
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.75 |
| Max. Negotiated Rate |
$378.22 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.16
|
| Rate for Payer: Cash Price |
$336.19
|
| Rate for Payer: Cofinity Commercial |
$294.17
|
| Rate for Payer: Cofinity Commercial |
$361.41
|
| Rate for Payer: Healthscope Commercial |
$378.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.20
|
| Rate for Payer: PHP Commercial |
$357.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.17
|
| Rate for Payer: Priority Health SBD |
$264.75
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.89 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| 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 |
$109.89
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| 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 |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$292.73
|
| 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 |
$241.07
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$196.47
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.97 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health SBD |
$216.97
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| 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 |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| 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 |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$292.73
|
| 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 |
$241.07
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$227.24
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.97 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health SBD |
$216.97
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.68 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| 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 |
$96.68
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| 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 |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$292.73
|
| 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 |
$241.07
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$216.97
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$195.48
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.97 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health SBD |
$216.97
|
|
|
HC CLOSURE DEVICE
|
Facility
|
IP
|
$1,116.14
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.17 |
| Max. Negotiated Rate |
$1,004.53 |
| Rate for Payer: Aetna Commercial |
$948.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.49
|
| Rate for Payer: Cash Price |
$892.91
|
| Rate for Payer: Cofinity Commercial |
$781.30
|
| Rate for Payer: Cofinity Commercial |
$959.88
|
| Rate for Payer: Healthscope Commercial |
$1,004.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$948.72
|
| Rate for Payer: PHP Commercial |
$948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health SBD |
$703.17
|
|
|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,116.14
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.46 |
| Max. Negotiated Rate |
$1,004.53 |
| Rate for Payer: Aetna Commercial |
$948.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$725.49
|
| Rate for Payer: BCBS Complete |
$446.46
|
| Rate for Payer: Cash Price |
$892.91
|
| Rate for Payer: Cofinity Commercial |
$781.30
|
| Rate for Payer: Cofinity Commercial |
$959.88
|
| Rate for Payer: Healthscope Commercial |
$1,004.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$948.72
|
| Rate for Payer: PHP Commercial |
$948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health SBD |
$703.17
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| 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 |
$11.57
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$11.02
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Meridian Medicaid |
$11.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.18
|
| Rate for Payer: UHC Core |
$30.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Exchange |
$20.15
|
| Rate for Payer: UHC Medicare Advantage |
$20.75
|
| Rate for Payer: VA VA |
$20.15
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.00
|
| 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 |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| 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 |
$510.00
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$510.00
|
| 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 |
$420.00
|
| 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 |
$378.00
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$343.16
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
