|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$302.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$326.43
|
| Rate for Payer: ASR Commercial |
$326.43
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$275.58
|
| Rate for Payer: BCN Commercial |
$260.91
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Healthscope Whirlpool |
$326.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.87
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$235.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$282.91
|
| Rate for Payer: ASR Commercial |
$282.91
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$238.84
|
| Rate for Payer: BCN Commercial |
$226.12
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$291.66
|
| Rate for Payer: Healthscope Whirlpool |
$282.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.91
|
| Rate for Payer: Nomi Health Commercial |
$239.16
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.55
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$204.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$189.58 |
| Max. Negotiated Rate |
$291.66 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: ASR ASR |
$282.91
|
| Rate for Payer: ASR Commercial |
$282.91
|
| Rate for Payer: BCBS Trust/PPO |
$237.67
|
| Rate for Payer: BCN Commercial |
$226.12
|
| Rate for Payer: Cash Price |
$233.33
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.33
|
| Rate for Payer: Healthscope Commercial |
$291.66
|
| Rate for Payer: Healthscope Whirlpool |
$282.91
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.91
|
| Rate for Payer: Nomi Health Commercial |
$239.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.66
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$622.66 |
| Rate for Payer: Aetna Commercial |
$560.39
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$603.98
|
| Rate for Payer: ASR Commercial |
$603.98
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$509.90
|
| Rate for Payer: BCN Commercial |
$482.75
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$585.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$622.66
|
| Rate for Payer: Healthscope Whirlpool |
$603.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$560.39
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.26
|
| Rate for Payer: Nomi Health Commercial |
$510.58
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$404.73 |
| Max. Negotiated Rate |
$622.66 |
| Rate for Payer: Aetna Commercial |
$560.39
|
| Rate for Payer: ASR ASR |
$603.98
|
| Rate for Payer: ASR Commercial |
$603.98
|
| Rate for Payer: BCBS Trust/PPO |
$507.41
|
| Rate for Payer: BCN Commercial |
$482.75
|
| Rate for Payer: Cash Price |
$498.13
|
| Rate for Payer: Cofinity Commercial |
$585.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.13
|
| Rate for Payer: Healthscope Commercial |
$622.66
|
| Rate for Payer: Healthscope Whirlpool |
$603.98
|
| Rate for Payer: Mclaren Commercial |
$560.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.26
|
| Rate for Payer: Nomi Health Commercial |
$510.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.94
|
|
|
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 |
$228.33 |
| Max. Negotiated Rate |
$351.28 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Trust/PPO |
$286.26
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$287.66
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$1,374.90 |
| Max. Negotiated Rate |
$2,115.23 |
| Rate for Payer: Aetna Commercial |
$1,903.71
|
| Rate for Payer: ASR ASR |
$2,051.77
|
| Rate for Payer: ASR Commercial |
$2,051.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,723.70
|
| Rate for Payer: BCN Commercial |
$1,639.94
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,988.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Healthscope Commercial |
$2,115.23
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.77
|
| Rate for Payer: Mclaren Commercial |
$1,903.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: Nomi Health Commercial |
$1,734.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,861.40
|
|
|
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 |
$840.47 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$1,903.71
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$2,051.77
|
| Rate for Payer: ASR Commercial |
$2,051.77
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.16
|
| Rate for Payer: BCN Commercial |
$1,639.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cash Price |
$1,692.18
|
| Rate for Payer: Cofinity Commercial |
$1,988.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$2,115.23
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$1,903.71
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,797.95
|
| Rate for Payer: Nomi Health Commercial |
$1,734.49
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,853.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,861.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$302.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$326.43
|
| Rate for Payer: ASR Commercial |
$326.43
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$275.58
|
| Rate for Payer: BCN Commercial |
$260.91
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Healthscope Whirlpool |
$326.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$218.74 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$302.88
|
| Rate for Payer: ASR ASR |
$326.43
|
| Rate for Payer: ASR Commercial |
$326.43
|
| Rate for Payer: BCBS Trust/PPO |
$274.24
|
| Rate for Payer: BCN Commercial |
$260.91
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Healthscope Whirlpool |
$326.43
|
| Rate for Payer: Mclaren Commercial |
$302.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.15
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$302.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$326.43
|
| Rate for Payer: ASR Commercial |
$326.43
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$275.58
|
| Rate for Payer: BCN Commercial |
$260.91
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Healthscope Whirlpool |
$326.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$302.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.86
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$195.89
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$218.74 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$302.88
|
| Rate for Payer: ASR ASR |
$326.43
|
| Rate for Payer: ASR Commercial |
$326.43
|
| Rate for Payer: BCBS Trust/PPO |
$274.24
|
| Rate for Payer: BCN Commercial |
$260.91
|
| Rate for Payer: Cash Price |
$269.22
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.22
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Healthscope Whirlpool |
$326.43
|
| Rate for Payer: Mclaren Commercial |
$302.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.05
|
| Rate for Payer: Nomi Health Commercial |
$275.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.15
|
|
|
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 |
$209.16 |
| Max. Negotiated Rate |
$321.79 |
| Rate for Payer: Aetna Commercial |
$289.61
|
| Rate for Payer: ASR ASR |
$312.14
|
| Rate for Payer: ASR Commercial |
$312.14
|
| Rate for Payer: BCBS Trust/PPO |
$262.23
|
| Rate for Payer: BCN Commercial |
$249.48
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$302.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Healthscope Commercial |
$321.79
|
| Rate for Payer: Healthscope Whirlpool |
$312.14
|
| Rate for Payer: Mclaren Commercial |
$289.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: Nomi Health Commercial |
$263.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.18
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$289.61
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$312.14
|
| Rate for Payer: ASR Commercial |
$312.14
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$263.51
|
| Rate for Payer: BCN Commercial |
$249.48
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cash Price |
$257.43
|
| Rate for Payer: Cofinity Commercial |
$302.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$321.79
|
| Rate for Payer: Healthscope Whirlpool |
$312.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$289.61
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.52
|
| Rate for Payer: Nomi Health Commercial |
$263.87
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.27
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$190.62
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$428.64 |
| Rate for Payer: Aetna Commercial |
$385.78
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$415.78
|
| Rate for Payer: ASR Commercial |
$415.78
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$351.01
|
| Rate for Payer: BCN Commercial |
$332.32
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$402.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$428.64
|
| Rate for Payer: Healthscope Whirlpool |
$415.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$385.78
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: Nomi Health Commercial |
$351.48
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.57
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$300.48
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$278.62 |
| Max. Negotiated Rate |
$428.64 |
| Rate for Payer: Aetna Commercial |
$385.78
|
| Rate for Payer: ASR ASR |
$415.78
|
| Rate for Payer: ASR Commercial |
$415.78
|
| Rate for Payer: BCBS Trust/PPO |
$349.30
|
| Rate for Payer: BCN Commercial |
$332.32
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$402.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Healthscope Commercial |
$428.64
|
| Rate for Payer: Healthscope Whirlpool |
$415.78
|
| Rate for Payer: Mclaren Commercial |
$385.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.34
|
| Rate for Payer: Nomi Health Commercial |
$351.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.20
|
|
|
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 |
$236.13 |
| Max. Negotiated Rate |
$363.27 |
| Rate for Payer: Aetna Commercial |
$326.94
|
| Rate for Payer: ASR ASR |
$352.37
|
| Rate for Payer: ASR Commercial |
$352.37
|
| Rate for Payer: BCBS Trust/PPO |
$296.03
|
| Rate for Payer: BCN Commercial |
$281.64
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$341.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Healthscope Commercial |
$363.27
|
| Rate for Payer: Healthscope Whirlpool |
$352.37
|
| Rate for Payer: Mclaren Commercial |
$326.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$297.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.68
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$326.94
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$352.37
|
| Rate for Payer: ASR Commercial |
$352.37
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$297.48
|
| Rate for Payer: BCN Commercial |
$281.64
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cash Price |
$290.62
|
| Rate for Payer: Cofinity Commercial |
$341.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$363.27
|
| Rate for Payer: Healthscope Whirlpool |
$352.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$326.94
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$297.88
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$287.66
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.79
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$246.25
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$228.33 |
| Max. Negotiated Rate |
$351.28 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Trust/PPO |
$286.26
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
|
|
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 |
$228.33 |
| Max. Negotiated Rate |
$351.28 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Trust/PPO |
$286.26
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
|
|
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 |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$316.15
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$340.74
|
| Rate for Payer: ASR Commercial |
$340.74
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$287.66
|
| Rate for Payer: BCN Commercial |
$272.35
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$351.28
|
| Rate for Payer: Healthscope Whirlpool |
$340.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$316.15
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.59
|
| Rate for Payer: Nomi Health Commercial |
$288.05
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
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 |
$1,138.46 |
| Rate for Payer: Aetna Commercial |
$1,024.61
|
| Rate for Payer: Aetna Medicare |
$569.23
|
| Rate for Payer: ASR ASR |
$1,104.31
|
| Rate for Payer: ASR Commercial |
$1,104.31
|
| Rate for Payer: BCBS Complete |
$455.38
|
| Rate for Payer: BCBS Trust/PPO |
$932.28
|
| Rate for Payer: BCN Commercial |
$882.65
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$1,070.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,138.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.31
|
| Rate for Payer: Mclaren Commercial |
$1,024.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: Nomi Health Commercial |
$933.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$997.52
|
| Rate for Payer: Priority Health Narrow Network |
$798.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.84
|
|
|
HC CLOSURE DEVICE
|
Facility
|
IP
|
$1,138.46
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.00 |
| Max. Negotiated Rate |
$1,138.46 |
| Rate for Payer: Aetna Commercial |
$1,024.61
|
| Rate for Payer: ASR ASR |
$1,104.31
|
| Rate for Payer: ASR Commercial |
$1,104.31
|
| Rate for Payer: BCBS Trust/PPO |
$927.73
|
| Rate for Payer: BCN Commercial |
$882.65
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$1,070.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,138.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.31
|
| Rate for Payer: Mclaren Commercial |
$1,024.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: Nomi Health Commercial |
$933.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.84
|
|
