|
HC CLOSED RX TIBIAL PLATEAU FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
76100172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.74 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Advantage |
$250.82
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health SBD |
$225.74
|
|
|
HC CLOSED RX TIBIA SHAFT FX
|
Facility
|
OP
|
$394.14
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
76100173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$335.02
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$261.73
|
| Rate for Payer: BCN Commercial |
$261.73
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$315.31
|
| Rate for Payer: Cash Price |
$315.31
|
| Rate for Payer: Cash Price |
$315.31
|
| Rate for Payer: Cofinity Advantage |
$275.90
|
| Rate for Payer: Cofinity Commercial |
$338.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$354.73
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.02
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.61
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$335.02
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$248.31
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.19
|
| Rate for Payer: UHC Core |
$205.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$154.90
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX TIBIA SHAFT FX
|
Facility
|
IP
|
$394.14
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
76100173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.31 |
| Max. Negotiated Rate |
$354.73 |
| Rate for Payer: Aetna Commercial |
$335.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.19
|
| Rate for Payer: Cash Price |
$315.31
|
| Rate for Payer: Cofinity Advantage |
$275.90
|
| Rate for Payer: Cofinity Commercial |
$338.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.31
|
| Rate for Payer: Healthscope Commercial |
$354.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.61
|
| Rate for Payer: PHP Commercial |
$335.02
|
| Rate for Payer: Priority Health SBD |
$248.31
|
|
|
HC CLOSED TREATMENT DISLOCATED SHOULDER W MANIP
|
Facility
|
IP
|
$647.33
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.82 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$550.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.76
|
| Rate for Payer: Cash Price |
$517.86
|
| Rate for Payer: Cofinity Advantage |
$453.13
|
| Rate for Payer: Cofinity Commercial |
$556.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.86
|
| Rate for Payer: Healthscope Commercial |
$582.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.50
|
| Rate for Payer: PHP Commercial |
$550.23
|
| Rate for Payer: Priority Health SBD |
$407.82
|
|
|
HC CLOSED TREATMENT DISLOCATED SHOULDER W MANIP
|
Facility
|
OP
|
$647.33
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$550.23
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$227.14
|
| Rate for Payer: BCN Commercial |
$227.14
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$517.86
|
| Rate for Payer: Cash Price |
$517.86
|
| Rate for Payer: Cash Price |
$517.86
|
| Rate for Payer: Cofinity Advantage |
$453.13
|
| Rate for Payer: Cofinity Commercial |
$556.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$582.60
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.23
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.50
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$550.23
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$407.82
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.76
|
| Rate for Payer: UHC Core |
$337.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$254.40
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX ACETAB FX; W/O MANIP
|
Facility
|
IP
|
$389.47
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
76100286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.37 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$331.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.16
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Advantage |
$272.63
|
| Rate for Payer: Cofinity Commercial |
$334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Healthscope Commercial |
$350.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.10
|
| Rate for Payer: PHP Commercial |
$331.05
|
| Rate for Payer: Priority Health SBD |
$245.37
|
|
|
HC CLOSED TX ACETAB FX; W/O MANIP
|
Facility
|
OP
|
$389.47
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
76100286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$331.05
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Advantage |
$272.63
|
| Rate for Payer: Cofinity Commercial |
$334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$350.52
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.05
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.10
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$331.05
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$245.37
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.16
|
| Rate for Payer: UHC Core |
$202.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$153.06
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX BIMALLEOLAR ANKLE FX W/O MANIP
|
Facility
|
IP
|
$638.72
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.39 |
| Max. Negotiated Rate |
$574.85 |
| Rate for Payer: Aetna Commercial |
$542.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.17
|
| Rate for Payer: Cash Price |
$510.98
|
| Rate for Payer: Cofinity Advantage |
$447.10
|
| Rate for Payer: Cofinity Commercial |
$549.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.98
|
| Rate for Payer: Healthscope Commercial |
$574.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.04
|
| Rate for Payer: PHP Commercial |
$542.91
|
| Rate for Payer: Priority Health SBD |
$402.39
|
|
|
HC CLOSED TX BIMALLEOLAR ANKLE FX W/O MANIP
|
Facility
|
OP
|
$638.72
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$542.91
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$123.64
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$510.98
|
| Rate for Payer: Cash Price |
$510.98
|
| Rate for Payer: Cash Price |
$510.98
|
| Rate for Payer: Cofinity Advantage |
$447.10
|
| Rate for Payer: Cofinity Commercial |
$549.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$574.85
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.91
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.04
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$542.91
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$402.39
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.17
|
| Rate for Payer: UHC Core |
$332.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$251.02
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX BIMALLEOLAR FX W/MANIP
|
Facility
|
OP
|
$1,846.51
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.08 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$1,569.53
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$547.08
|
| Rate for Payer: BCN Commercial |
$547.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$1,477.21
|
| Rate for Payer: Cash Price |
$1,477.21
|
| Rate for Payer: Cash Price |
$1,477.21
|
| Rate for Payer: Cofinity Advantage |
$1,292.56
|
| Rate for Payer: Cofinity Commercial |
$1,588.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$1,661.86
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.53
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,384.88
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$1,569.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$1,163.30
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,200.23
|
| Rate for Payer: UHC Core |
$962.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$725.68
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC CLOSED TX BIMALLEOLAR FX W/MANIP
|
Facility
|
IP
|
$1,846.51
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,163.30 |
| Max. Negotiated Rate |
$1,661.86 |
| Rate for Payer: Aetna Commercial |
$1,569.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.23
|
| Rate for Payer: Cash Price |
$1,477.21
|
| Rate for Payer: Cofinity Advantage |
$1,292.56
|
| Rate for Payer: Cofinity Commercial |
$1,588.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.21
|
| Rate for Payer: Healthscope Commercial |
$1,661.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,384.88
|
| Rate for Payer: PHP Commercial |
$1,569.53
|
| Rate for Payer: Priority Health SBD |
$1,163.30
|
|
|
HC CLOSED TX CALCANEAL FX, W/O MANIP
|
Facility
|
IP
|
$343.26
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.25 |
| Max. Negotiated Rate |
$308.93 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: Priority Health SBD |
$216.25
|
|
|
HC CLOSED TX CALCANEAL FX, W/O MANIP
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$216.25
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.12
|
| Rate for Payer: UHC Core |
$178.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$134.90
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX CLAVICLE FX W/O MANIP
|
Facility
|
OP
|
$343.23
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
76100229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$291.75
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$142.28
|
| Rate for Payer: BCN Commercial |
$142.28
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$274.58
|
| Rate for Payer: Cash Price |
$274.58
|
| Rate for Payer: Cash Price |
$274.58
|
| Rate for Payer: Cofinity Advantage |
$240.26
|
| Rate for Payer: Cofinity Commercial |
$295.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$308.91
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.75
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.42
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$291.75
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$216.23
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.10
|
| Rate for Payer: UHC Core |
$178.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$134.89
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX CLAVICLE FX W/O MANIP
|
Facility
|
IP
|
$343.23
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
76100229
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.23 |
| Max. Negotiated Rate |
$308.91 |
| Rate for Payer: Aetna Commercial |
$291.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.10
|
| Rate for Payer: Cash Price |
$274.58
|
| Rate for Payer: Cofinity Advantage |
$240.26
|
| Rate for Payer: Cofinity Commercial |
$295.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.58
|
| Rate for Payer: Healthscope Commercial |
$308.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.42
|
| Rate for Payer: PHP Commercial |
$291.75
|
| Rate for Payer: Priority Health SBD |
$216.23
|
|
|
HC CLOSED TX DISTAL RADIAL FX/EPIPHYSEAL SEPARATION W/MANIP
|
Facility
|
OP
|
$2,157.53
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.34 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$1,833.90
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$529.34
|
| Rate for Payer: BCN Commercial |
$529.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$1,726.02
|
| Rate for Payer: Cash Price |
$1,726.02
|
| Rate for Payer: Cash Price |
$1,726.02
|
| Rate for Payer: Cofinity Advantage |
$1,510.27
|
| Rate for Payer: Cofinity Commercial |
$1,855.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$1,941.78
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.90
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,618.15
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$1,833.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$1,359.24
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,402.39
|
| Rate for Payer: UHC Core |
$1,124.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$847.91
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC CLOSED TX DISTAL RADIAL FX/EPIPHYSEAL SEPARATION W/MANIP
|
Facility
|
IP
|
$2,157.53
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,359.24 |
| Max. Negotiated Rate |
$1,941.78 |
| Rate for Payer: Aetna Commercial |
$1,833.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.39
|
| Rate for Payer: Cash Price |
$1,726.02
|
| Rate for Payer: Cofinity Advantage |
$1,510.27
|
| Rate for Payer: Cofinity Commercial |
$1,855.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.02
|
| Rate for Payer: Healthscope Commercial |
$1,941.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,618.15
|
| Rate for Payer: PHP Commercial |
$1,833.90
|
| Rate for Payer: Priority Health SBD |
$1,359.24
|
|
|
HC CLOSED TX FEMORAL FX, DISTAL END, MEDIAL/LAT CONDYLE W/O MANIP
|
Facility
|
IP
|
$372.48
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.66 |
| Max. Negotiated Rate |
$335.23 |
| Rate for Payer: Aetna Commercial |
$316.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.11
|
| Rate for Payer: Cash Price |
$297.98
|
| Rate for Payer: Cofinity Advantage |
$260.74
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.98
|
| Rate for Payer: Healthscope Commercial |
$335.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.36
|
| Rate for Payer: PHP Commercial |
$316.61
|
| Rate for Payer: Priority Health SBD |
$234.66
|
|
|
HC CLOSED TX FEMORAL FX, DISTAL END, MEDIAL/LAT CONDYLE W/O MANIP
|
Facility
|
OP
|
$372.48
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$316.61
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$297.98
|
| Rate for Payer: Cash Price |
$297.98
|
| Rate for Payer: Cash Price |
$297.98
|
| Rate for Payer: Cofinity Advantage |
$260.74
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$335.23
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.61
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.36
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$316.61
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$234.66
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.11
|
| Rate for Payer: UHC Core |
$194.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$146.38
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX FRACTURE WB ARTICLR PRTN DSTL TIBIA WO MANIP
|
Facility
|
IP
|
$678.30
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.33 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna Commercial |
$576.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.89
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Advantage |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.73
|
| Rate for Payer: PHP Commercial |
$576.55
|
| Rate for Payer: Priority Health SBD |
$427.33
|
|
|
HC CLOSED TX FRACTURE WB ARTICLR PRTN DSTL TIBIA WO MANIP
|
Facility
|
OP
|
$678.30
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$576.55
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Advantage |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$576.55
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$427.33
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.89
|
| Rate for Payer: UHC Core |
$353.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$266.57
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX GREAT TOE FX W/O MANIPULATION
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$88.90
|
| Rate for Payer: BCN Commercial |
$88.90
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$216.25
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.12
|
| Rate for Payer: UHC Core |
$178.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$134.90
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX GREAT TOE FX W/O MANIPULATION
|
Facility
|
IP
|
$343.26
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.25 |
| Max. Negotiated Rate |
$308.93 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: Priority Health SBD |
$216.25
|
|
|
HC CLOSED TX GR TROCHANTERIC FX W/O MANIP
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$297.74
|
| Rate for Payer: BCN Commercial |
$297.74
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$216.25
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.12
|
| Rate for Payer: UHC Core |
$178.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$134.90
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX GR TROCHANTERIC FX W/O MANIP
|
Facility
|
IP
|
$343.26
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.25 |
| Max. Negotiated Rate |
$308.93 |
| Rate for Payer: Aetna Commercial |
$291.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.12
|
| Rate for Payer: Cash Price |
$274.61
|
| Rate for Payer: Cofinity Advantage |
$240.28
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.61
|
| Rate for Payer: Healthscope Commercial |
$308.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.44
|
| Rate for Payer: PHP Commercial |
$291.77
|
| Rate for Payer: Priority Health SBD |
$216.25
|
|
