|
HC CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
76100279
|
|
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 TALUS FX; W/O MANIP
|
Facility
|
IP
|
$297.49
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$267.74 |
| Rate for Payer: Aetna Commercial |
$252.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.37
|
| Rate for Payer: Cash Price |
$237.99
|
| Rate for Payer: Cofinity Advantage |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$255.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.99
|
| Rate for Payer: Healthscope Commercial |
$267.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: PHP Commercial |
$252.87
|
| Rate for Payer: Priority Health SBD |
$187.42
|
|
|
HC CLOSED TX TALUS FX; W/O MANIP
|
Facility
|
OP
|
$297.49
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$252.87
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.37
|
| 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 |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$237.99
|
| Rate for Payer: Cash Price |
$237.99
|
| Rate for Payer: Cash Price |
$237.99
|
| Rate for Payer: Cofinity Advantage |
$208.24
|
| Rate for Payer: Cofinity Commercial |
$255.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$267.74
|
| 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 |
$252.87
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.12
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$252.87
|
| 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 |
$187.42
|
| 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) |
$193.37
|
| Rate for Payer: UHC Core |
$154.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Advantage |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.33
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: Priority Health SBD |
$400.12
|
|
|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| 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 |
$206.92
|
| Rate for Payer: BCN Commercial |
$206.92
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Advantage |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| 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 |
$539.84
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.33
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$539.84
|
| 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 |
$400.12
|
| 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) |
$412.82
|
| Rate for Payer: UHC Core |
$330.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$249.60
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| 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 |
$70.09
|
| Rate for Payer: BCN Commercial |
$70.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| 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: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| 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 |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$304.56
|
| 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 |
$225.74
|
| 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) |
$232.90
|
| Rate for Payer: UHC Core |
$186.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$140.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
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 TX TRIMALLEOLAR FX W/O MANIP
|
Facility
|
OP
|
$719.10
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$611.24
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.42
|
| 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 |
$575.28
|
| Rate for Payer: Cash Price |
$575.28
|
| Rate for Payer: Cash Price |
$575.28
|
| Rate for Payer: Cofinity Advantage |
$503.37
|
| Rate for Payer: Cofinity Commercial |
$618.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$647.19
|
| 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 |
$611.24
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.33
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$611.24
|
| 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 |
$453.03
|
| 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) |
$467.42
|
| Rate for Payer: UHC Core |
$374.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$282.61
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX TRIMALLEOLAR FX W/O MANIP
|
Facility
|
IP
|
$719.10
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.03 |
| Max. Negotiated Rate |
$647.19 |
| Rate for Payer: Aetna Commercial |
$611.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.42
|
| Rate for Payer: Cash Price |
$575.28
|
| Rate for Payer: Cofinity Advantage |
$503.37
|
| Rate for Payer: Cofinity Commercial |
$618.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.28
|
| Rate for Payer: Healthscope Commercial |
$647.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.33
|
| Rate for Payer: PHP Commercial |
$611.24
|
| Rate for Payer: Priority Health SBD |
$453.03
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
OP
|
$2,157.53
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.67 |
| 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 |
$584.67
|
| Rate for Payer: BCN Commercial |
$584.67
|
| 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 ULNAR FX PROX END
|
Facility
|
IP
|
$2,157.53
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
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 ULNAR FX, PROX END W/O MANIP
|
Facility
|
IP
|
$343.26
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
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 ULNAR FX, PROX END W/O MANIP
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.64 |
| 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 |
$123.64
|
| Rate for Payer: BCN Commercial |
$123.64
|
| 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 ULNAR SHAFT FX, W/O MANIP
|
Facility
|
OP
|
$343.26
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| 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 |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| 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 ULNAR SHAFT FX, W/O MANIP
|
Facility
|
IP
|
$343.26
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
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 ULNAR STYLOID FX
|
Facility
|
OP
|
$328.23
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.35
|
| 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 |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$262.58
|
| Rate for Payer: Cash Price |
$262.58
|
| Rate for Payer: Cash Price |
$262.58
|
| Rate for Payer: Cofinity Advantage |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$282.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$295.41
|
| 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 |
$279.00
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.17
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$279.00
|
| 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 |
$206.78
|
| 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) |
$213.35
|
| Rate for Payer: UHC Core |
$171.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$128.99
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
IP
|
$328.23
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.78 |
| Max. Negotiated Rate |
$295.41 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.35
|
| Rate for Payer: Cash Price |
$262.58
|
| Rate for Payer: Cofinity Advantage |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$282.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.58
|
| Rate for Payer: Healthscope Commercial |
$295.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.17
|
| Rate for Payer: PHP Commercial |
$279.00
|
| Rate for Payer: Priority Health SBD |
$206.78
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
OP
|
$437.21
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$371.63
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.19
|
| 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 |
$131.18
|
| Rate for Payer: BCN Commercial |
$131.18
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cofinity Advantage |
$306.05
|
| Rate for Payer: Cofinity Commercial |
$376.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$393.49
|
| 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 |
$371.63
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.91
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$371.63
|
| 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 |
$275.44
|
| 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) |
$284.19
|
| Rate for Payer: UHC Core |
$227.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$171.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
IP
|
$437.21
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.44 |
| Max. Negotiated Rate |
$393.49 |
| Rate for Payer: Aetna Commercial |
$371.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.19
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cofinity Advantage |
$306.05
|
| Rate for Payer: Cofinity Commercial |
$376.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.77
|
| Rate for Payer: Healthscope Commercial |
$393.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.91
|
| Rate for Payer: PHP Commercial |
$371.63
|
| Rate for Payer: Priority Health SBD |
$275.44
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
IP
|
$370.54
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.44 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna Commercial |
$314.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.85
|
| Rate for Payer: Cash Price |
$296.43
|
| Rate for Payer: Cofinity Advantage |
$259.38
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.43
|
| Rate for Payer: Healthscope Commercial |
$333.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.90
|
| Rate for Payer: PHP Commercial |
$314.96
|
| Rate for Payer: Priority Health SBD |
$233.44
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
OP
|
$370.54
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$314.96
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.85
|
| 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 |
$144.94
|
| Rate for Payer: BCN Commercial |
$144.94
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$296.43
|
| Rate for Payer: Cash Price |
$296.43
|
| Rate for Payer: Cash Price |
$296.43
|
| Rate for Payer: Cofinity Advantage |
$259.38
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$333.49
|
| 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 |
$314.96
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.90
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$314.96
|
| 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 |
$233.44
|
| 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) |
$240.85
|
| Rate for Payer: UHC Core |
$193.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$145.62
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
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 CLOSE RX FINGR ARTICULAR FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| 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 |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| 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: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| 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 |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$304.56
|
| 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 |
$225.74
|
| 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) |
$232.90
|
| Rate for Payer: UHC Core |
$186.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$140.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
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 CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.52 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| 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 |
$127.52
|
| Rate for Payer: BCN Commercial |
$127.52
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| 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: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| 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 |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$304.56
|
| 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 |
$225.74
|
| 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) |
$232.90
|
| Rate for Payer: UHC Core |
$186.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$140.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
