|
HC CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.01 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$212.01
|
|
|
HC CLOSED TX TALUS FX; W/O MANIP
|
Facility
|
OP
|
$291.66
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$247.91
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cofinity Commercial |
$250.83
|
| Rate for Payer: Cofinity Commercial |
$204.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.91
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$247.91
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.58
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$183.75
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX TALUS FX; W/O MANIP
|
Facility
|
IP
|
$291.66
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
76100288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Aetna Commercial |
$247.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.58
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cofinity Commercial |
$204.16
|
| Rate for Payer: Cofinity Commercial |
$250.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.33
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.91
|
| Rate for Payer: PHP Commercial |
$247.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.58
|
| Rate for Payer: Priority Health SBD |
$183.75
|
|
|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
OP
|
$622.66
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.26
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.73
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$392.28
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX TOE FX W MANIPULATION
|
Facility
|
IP
|
$622.66
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$560.39 |
| Rate for Payer: Aetna Commercial |
$529.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.73
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$435.86
|
| Rate for Payer: Cofinity Commercial |
$535.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Healthscope Commercial |
$560.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.26
|
| Rate for Payer: PHP Commercial |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.73
|
| Rate for Payer: Priority Health SBD |
$392.28
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX TOE FX WO MANIPULATION
|
Facility
|
IP
|
$351.28
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
76100176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health SBD |
$221.31
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
OP
|
$2,115.23
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,819.10
|
| Rate for Payer: Cofinity Commercial |
$1,480.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,480.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$1,797.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$1,332.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC CLOSED TX ULNAR FX PROX END
|
Facility
|
IP
|
$2,115.23
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,332.59 |
| Max. Negotiated Rate |
$1,903.71 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.90
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,480.66
|
| Rate for Payer: Cofinity Commercial |
$1,819.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,480.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Healthscope Commercial |
$1,903.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: PHP Commercial |
$1,797.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health SBD |
$1,332.59
|
|
|
HC CLOSED TX ULNAR FX, PROX END W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.01 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$212.01
|
|
|
HC CLOSED TX ULNAR FX, PROX END W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
76100275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX ULNAR SHAFT FX, W/O MANIP
|
Facility
|
OP
|
$336.53
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX ULNAR SHAFT FX, W/O MANIP
|
Facility
|
IP
|
$336.53
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.01 |
| Max. Negotiated Rate |
$302.88 |
| Rate for Payer: Aetna Commercial |
$286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.74
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$289.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$302.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: PHP Commercial |
$286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health SBD |
$212.01
|
|
|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
OP
|
$321.79
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Cofinity Commercial |
$225.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$202.73
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSED TX ULNAR STYLOID FX
|
Facility
|
IP
|
$321.79
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.73 |
| Max. Negotiated Rate |
$289.61 |
| Rate for Payer: Aetna Commercial |
$273.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.16
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$225.25
|
| Rate for Payer: Cofinity Commercial |
$276.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Healthscope Commercial |
$289.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: PHP Commercial |
$273.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health SBD |
$202.73
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
IP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.04 |
| Max. Negotiated Rate |
$385.78 |
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health SBD |
$270.04
|
|
|
HC CLOSED TX VERT BODY FX, W/O MANIP, REQUIRING/INCL CAST/BRACE
|
Facility
|
OP
|
$428.64
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$270.04
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
OP
|
$363.27
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Cofinity Commercial |
$254.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$228.86
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSE RX DIST FINGR FX
|
Facility
|
IP
|
$363.27
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
76100170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$326.94 |
| Rate for Payer: Aetna Commercial |
$308.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.13
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$254.29
|
| Rate for Payer: Cofinity Commercial |
$312.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: PHP Commercial |
$308.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health SBD |
$228.86
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSE RX FINGR ARTICULAR FX
|
Facility
|
IP
|
$351.28
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health SBD |
$221.31
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$351.28
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$221.31
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLOSE RX PROX/MID FING SHFT FX
|
Facility
|
IP
|
$351.28
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
76100168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$316.15 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.33
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: PHP Commercial |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health SBD |
$221.31
|
|
|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,138.46
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.38 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: Aetna Medicare |
$569.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.00
|
| Rate for Payer: BCBS Complete |
$455.38
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$796.92
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health SBD |
$717.23
|
|
