|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
IP
|
$2,710.48
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,897.34 |
| Max. Negotiated Rate |
$2,710.48 |
| Rate for Payer: Aetna Commercial |
$2,439.43
|
| Rate for Payer: ASR ASR |
$2,629.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,101.44
|
| Rate for Payer: BCN Commercial |
$2,101.44
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,547.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,168.38
|
| Rate for Payer: Healthscope Commercial |
$2,710.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,629.17
|
| Rate for Payer: Mclaren Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,385.22
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
OP
|
$2,710.48
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.33 |
| Max. Negotiated Rate |
$2,710.48 |
| Rate for Payer: Aetna Commercial |
$2,439.43
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$2,629.17
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,101.44
|
| Rate for Payer: BCN Commercial |
$2,101.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,547.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,168.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$2,710.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,629.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$2,439.43
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,466.54
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,924.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,385.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
HC CITRIC ACID URINE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC CITRIC ACID URINE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$27.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.75
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$15.97
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$40.33
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.80
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$15.21
|
| Rate for Payer: Mclaren Medicare |
$27.80
|
| Rate for Payer: Meridian Medicaid |
$15.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PACE Medicare |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$30.58
|
| Rate for Payer: PHP Medicaid |
$15.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.34
|
| Rate for Payer: Priority Health Medicare |
$27.80
|
| Rate for Payer: Priority Health Narrow Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Medicare Advantage |
$28.63
|
| Rate for Payer: VA VA |
$27.80
|
|
|
HC CK-MB FRACTION
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.44
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: BCBS Complete |
$6.63
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$77.50
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.55
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Medicaid |
$6.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: PHP Medicaid |
$6.32
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.39
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health Narrow Network |
$121.91
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.90
|
| Rate for Payer: VA VA |
$11.55
|
|
|
HC CK-MB FRACTION
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: BCBS Trust/PPO |
$77.50
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC CLAM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC CLAM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
IP
|
$775.77
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.04 |
| Max. Negotiated Rate |
$775.77 |
| Rate for Payer: Aetna Commercial |
$698.19
|
| Rate for Payer: ASR ASR |
$752.50
|
| Rate for Payer: BCBS Trust/PPO |
$601.45
|
| Rate for Payer: BCN Commercial |
$601.45
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$729.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Healthscope Commercial |
$775.77
|
| Rate for Payer: Healthscope Whirlpool |
$752.50
|
| Rate for Payer: Mclaren Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.68
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
OP
|
$775.77
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$775.77 |
| Rate for Payer: Aetna Commercial |
$698.19
|
| Rate for Payer: ASR ASR |
$752.50
|
| Rate for Payer: BCBS Complete |
$310.31
|
| Rate for Payer: BCBS Trust/PPO |
$601.45
|
| Rate for Payer: BCN Commercial |
$601.45
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$729.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Healthscope Commercial |
$775.77
|
| Rate for Payer: Healthscope Whirlpool |
$752.50
|
| Rate for Payer: Mclaren Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.95
|
| Rate for Payer: Priority Health Narrow Network |
$550.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.68
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
IP
|
$413.27
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.29 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
OP
|
$413.27
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
OP
|
$344.39
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.20
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$204.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC CLOSED RX NAVICULAR FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$344.39 |
| Rate for Payer: Aetna Commercial |
$309.95
|
| Rate for Payer: ASR ASR |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$267.01
|
| Rate for Payer: BCN Commercial |
$267.01
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$323.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.51
|
| Rate for Payer: Healthscope Commercial |
$344.39
|
| Rate for Payer: Healthscope Whirlpool |
$334.06
|
| Rate for Payer: Mclaren Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.06
|
|
