|
HC CK-MB FRACTION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$179.77 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| 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 |
$100.88
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$85.75
|
| Rate for Payer: BCN Commercial |
$85.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.55
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Mclaren Medicaid |
$11.55
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$12.71
|
| Rate for Payer: PHP Medicaid |
$6.19
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.77
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health Narrow Network |
$143.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.55
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicaid |
$6.04
|
| Rate for Payer: UHCCP DNSP |
$11.55
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.55
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CLAM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CLAM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
OP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$807.12 |
| Rate for Payer: Aetna Commercial |
$726.41
|
| Rate for Payer: Aetna Medicare |
$298.63
|
| Rate for Payer: ASR ASR |
$782.91
|
| Rate for Payer: BCBS Complete |
$322.85
|
| Rate for Payer: BCBS Trust/PPO |
$665.47
|
| Rate for Payer: BCN Commercial |
$665.47
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Commercial |
$758.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Healthscope Commercial |
$782.91
|
| Rate for Payer: Healthscope Whirlpool |
$807.12
|
| Rate for Payer: Mclaren Commercial |
$726.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$645.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Nomi Health Commercial |
$661.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$707.20
|
| Rate for Payer: Priority Health Narrow Network |
$565.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.27
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
IP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.34 |
| Max. Negotiated Rate |
$807.12 |
| Rate for Payer: Aetna Commercial |
$726.41
|
| Rate for Payer: ASR ASR |
$782.91
|
| Rate for Payer: BCBS Trust/PPO |
$662.81
|
| Rate for Payer: BCN Commercial |
$662.81
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Commercial |
$758.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Healthscope Commercial |
$782.91
|
| Rate for Payer: Healthscope Whirlpool |
$807.12
|
| Rate for Payer: Mclaren Commercial |
$726.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Nomi Health Commercial |
$661.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.27
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
OP
|
$368.03
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$331.23
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$356.99
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$303.44
|
| Rate for Payer: BCN Commercial |
$303.44
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Cofinity Commercial |
$345.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$356.99
|
| Rate for Payer: Healthscope Whirlpool |
$368.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$331.23
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$312.83
|
| Rate for Payer: Nomi Health Commercial |
$301.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.02
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX DIST RAD/ULNA FX
|
Facility
|
IP
|
$368.03
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
76100163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$368.03 |
| Rate for Payer: Aetna Commercial |
$331.23
|
| Rate for Payer: ASR ASR |
$356.99
|
| Rate for Payer: BCBS Trust/PPO |
$302.23
|
| Rate for Payer: BCN Commercial |
$302.23
|
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Cofinity Commercial |
$345.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.42
|
| Rate for Payer: Healthscope Commercial |
$356.99
|
| Rate for Payer: Healthscope Whirlpool |
$368.03
|
| Rate for Payer: Mclaren Commercial |
$331.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.83
|
| Rate for Payer: Nomi Health Commercial |
$301.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.87
|
|
|
HC CLOSED RX INTER/PERI/SUB-TROCHANTERIC FEM FX W/O MANIP
|
Facility
|
IP
|
$4,938.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,703.50 |
| Max. Negotiated Rate |
$4,938.00 |
| Rate for Payer: Aetna Commercial |
$4,444.20
|
| Rate for Payer: ASR ASR |
$4,789.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,055.09
|
| Rate for Payer: BCN Commercial |
$4,055.09
|
| Rate for Payer: Cash Price |
$3,950.40
|
| Rate for Payer: Cofinity Commercial |
$4,641.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,950.40
|
| Rate for Payer: Healthscope Commercial |
$4,789.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,938.00
|
| Rate for Payer: Mclaren Commercial |
$4,444.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,197.30
|
| Rate for Payer: Nomi Health Commercial |
$4,049.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,703.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,345.44
|
|
|
HC CLOSED RX INTER/PERI/SUB-TROCHANTERIC FEM FX W/O MANIP
|
Facility
|
OP
|
$4,938.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$4,938.00 |
| Rate for Payer: Aetna Commercial |
$4,444.20
|
| Rate for Payer: Aetna Medicare |
$1,602.21
|
| 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: ASR ASR |
$4,789.86
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$4,071.38
|
| Rate for Payer: BCN Commercial |
$4,071.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,950.40
|
| Rate for Payer: Cash Price |
$3,950.40
|
| Rate for Payer: Cofinity Commercial |
$4,641.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,950.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$4,789.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,938.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,602.21
|
| Rate for Payer: Mclaren Commercial |
$4,444.20
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| 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 |
$879.93
|
| 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 |
$4,197.30
|
| Rate for Payer: Nomi Health Commercial |
$4,049.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,703.50
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$1,762.43
|
| Rate for Payer: PHP Medicaid |
$858.78
|
| 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/Tiered Network |
$4,326.68
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,461.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,345.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$2,483.43
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP DNSP |
$1,602.21
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
76100166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$429.97 |
| Rate for Payer: Aetna Commercial |
$386.97
|
| Rate for Payer: ASR ASR |
$417.07
|
| Rate for Payer: BCBS Trust/PPO |
$353.09
|
| Rate for Payer: BCN Commercial |
$353.09
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$404.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$417.07
|
| Rate for Payer: Healthscope Whirlpool |
$429.97
|
| Rate for Payer: Mclaren Commercial |
$386.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.37
|
|
|
HC CLOSED RX METACARPAL FX, MANIP
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
76100167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$429.97 |
| Rate for Payer: Aetna Commercial |
$386.97
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$417.07
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$354.51
|
| Rate for Payer: BCN Commercial |
$354.51
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$404.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$417.07
|
| Rate for Payer: Healthscope Whirlpool |
$429.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$386.97
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX METATARSAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
76100175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX NAVICULAR FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$301.05
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$240.84
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX NAVICULAR FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX PATELLA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
76100171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$358.31 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$294.24
|
| Rate for Payer: BCN Commercial |
$294.24
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$336.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
|
|
HC CLOSED RX PATELLA FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
76100171
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$380.96 |
| Rate for Payer: Aetna Commercial |
$322.48
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$347.56
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$295.43
|
| Rate for Payer: BCN Commercial |
$295.43
|
| 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: Cofinity Commercial |
$336.81
|
| 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 |
$347.56
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| 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 |
$134.98
|
| 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 |
$293.81
|
| 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 |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| 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/Tiered Network |
$262.69
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$210.15
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
