|
HC CAST COLOR ROLL
|
Facility
|
OP
|
$60.34
|
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.29
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.24
|
| Rate for Payer: Priority Health SBD |
$38.01
|
|
|
HC CAST CYLINDER
|
Facility
|
IP
|
$400.07
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
70000006
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.05
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$280.05
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
| Rate for Payer: Priority Health SBD |
$252.04
|
|
|
HC CAST CYLINDER
|
Facility
|
OP
|
$400.07
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
70000006
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Cofinity Commercial |
$280.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.06
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.05
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$252.04
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$86.77
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST FINGER (CONTRACTURE)
|
Facility
|
OP
|
$205.97
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$185.37 |
| Rate for Payer: Aetna Commercial |
$175.07
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$38.91
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Cofinity Commercial |
$177.13
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$185.37
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.07
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$175.07
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.18
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$129.76
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$48.79
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC CAST FINGER (CONTRACTURE)
|
Facility
|
IP
|
$205.97
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$185.37 |
| Rate for Payer: Aetna Commercial |
$175.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.88
|
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Cofinity Commercial |
$177.13
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Healthscope Commercial |
$185.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.07
|
| Rate for Payer: PHP Commercial |
$175.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.18
|
| Rate for Payer: Priority Health SBD |
$129.76
|
|
|
HC CAST GAUNTLET
|
Facility
|
IP
|
$233.47
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
42100002
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$147.09 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$198.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.76
|
| Rate for Payer: Cash Price |
$186.78
|
| Rate for Payer: Cofinity Commercial |
$200.78
|
| Rate for Payer: Cofinity Commercial |
$163.43
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.45
|
| Rate for Payer: PHP Commercial |
$198.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.43
|
| Rate for Payer: Priority Health SBD |
$147.09
|
|
|
HC CAST GAUNTLET
|
Facility
|
OP
|
$233.47
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
42100002
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$210.12 |
| Rate for Payer: Aetna Commercial |
$198.45
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$88.72
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$186.78
|
| Rate for Payer: Cash Price |
$186.78
|
| Rate for Payer: Cofinity Commercial |
$200.78
|
| Rate for Payer: Cofinity Commercial |
$163.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$210.12
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.45
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$198.45
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.43
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$147.09
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$66.80
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC CAST HIP SPICA 1 AND 1 HALF OR BOTH
|
Facility
|
OP
|
$950.54
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
70000004
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$88.01 |
| Max. Negotiated Rate |
$855.49 |
| Rate for Payer: Aetna Commercial |
$807.96
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$88.01
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$760.43
|
| Rate for Payer: Cash Price |
$760.43
|
| Rate for Payer: Cofinity Commercial |
$817.46
|
| Rate for Payer: Cofinity Commercial |
$665.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$855.49
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.96
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$807.96
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.38
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$598.84
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$175.18
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST HIP SPICA 1 AND 1 HALF OR BOTH
|
Facility
|
IP
|
$950.54
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
70000004
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$598.84 |
| Max. Negotiated Rate |
$855.49 |
| Rate for Payer: Aetna Commercial |
$807.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.85
|
| Rate for Payer: Cash Price |
$760.43
|
| Rate for Payer: Cofinity Commercial |
$817.46
|
| Rate for Payer: Cofinity Commercial |
$665.38
|
| Rate for Payer: Healthscope Commercial |
$855.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.96
|
| Rate for Payer: PHP Commercial |
$807.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.38
|
| Rate for Payer: Priority Health SBD |
$598.84
|
|
|
HC CAST LONG ARM
|
Facility
|
OP
|
$302.65
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
42100001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$257.25
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$103.35
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$242.12
|
| Rate for Payer: Cash Price |
$242.12
|
| Rate for Payer: Cofinity Commercial |
$260.28
|
| Rate for Payer: Cofinity Commercial |
$211.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$272.38
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.25
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$257.25
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.86
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$190.67
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST LONG ARM
|
Facility
|
IP
|
$302.65
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
42100001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$190.67 |
| Max. Negotiated Rate |
$272.38 |
| Rate for Payer: Aetna Commercial |
$257.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.72
|
| Rate for Payer: Cash Price |
$242.12
|
| Rate for Payer: Cofinity Commercial |
$211.86
|
| Rate for Payer: Cofinity Commercial |
$260.28
|
| Rate for Payer: Healthscope Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.25
|
| Rate for Payer: PHP Commercial |
$257.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.86
|
| Rate for Payer: Priority Health SBD |
$190.67
|
|
|
HC CAST LONG LEG
|
Facility
|
OP
|
$403.61
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$124.33
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$254.27
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST LONG LEG
|
Facility
|
IP
|
$403.61
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$254.27 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health SBD |
$254.27
|
|
|
HC CAST PANTALOON
|
Facility
|
IP
|
$900.56
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
70000003
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$567.35 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.36
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$630.39
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health SBD |
$567.35
|
|
|
HC CAST PANTALOON
|
Facility
|
OP
|
$900.56
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
70000003
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$88.01 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$88.01
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$630.39
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$567.35
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$156.52
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST PTB WALKING
|
Facility
|
IP
|
$403.61
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
70000009
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$254.27 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health SBD |
$254.27
|
|
|
HC CAST PTB WALKING
|
Facility
|
OP
|
$403.61
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
70000009
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$254.27
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$85.46
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST REPAIR
|
Facility
|
OP
|
$175.30
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.12 |
| Max. Negotiated Rate |
$157.77 |
| Rate for Payer: Aetna Commercial |
$149.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.94
|
| Rate for Payer: BCBS Complete |
$70.12
|
| Rate for Payer: Cash Price |
$140.24
|
| Rate for Payer: Cofinity Commercial |
$122.71
|
| Rate for Payer: Cofinity Commercial |
$150.76
|
| Rate for Payer: Healthscope Commercial |
$157.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.00
|
| Rate for Payer: PHP Commercial |
$149.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.71
|
| Rate for Payer: Priority Health SBD |
$110.44
|
|
|
HC CAST REPAIR
|
Facility
|
IP
|
$175.30
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$157.77 |
| Rate for Payer: Aetna Commercial |
$149.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.94
|
| Rate for Payer: Cash Price |
$140.24
|
| Rate for Payer: Cofinity Commercial |
$122.71
|
| Rate for Payer: Cofinity Commercial |
$150.76
|
| Rate for Payer: Healthscope Commercial |
$157.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.00
|
| Rate for Payer: PHP Commercial |
$149.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.71
|
| Rate for Payer: Priority Health SBD |
$110.44
|
|
|
HC CAST RISSER BODY ONLY
|
Facility
|
OP
|
$303.31
|
|
|
Service Code
|
CPT 29010
|
| Hospital Charge Code |
70000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$88.01 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$88.01
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Cofinity Commercial |
$212.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$191.09
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$158.48
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST RISSER BODY ONLY
|
Facility
|
IP
|
$303.31
|
|
|
Service Code
|
CPT 29010
|
| Hospital Charge Code |
70000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$191.09 |
| Max. Negotiated Rate |
$272.98 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.15
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$212.32
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$191.09
|
|
|
HC CAST SHORT ARM
|
Facility
|
OP
|
$293.81
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$249.74
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$235.05
|
| Rate for Payer: Cash Price |
$235.05
|
| Rate for Payer: Cofinity Commercial |
$252.68
|
| Rate for Payer: Cofinity Commercial |
$205.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$264.43
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.74
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$249.74
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.67
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$185.10
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$61.89
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST SHORT ARM
|
Facility
|
IP
|
$293.81
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$264.43 |
| Rate for Payer: Aetna Commercial |
$249.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.98
|
| Rate for Payer: Cash Price |
$235.05
|
| Rate for Payer: Cofinity Commercial |
$252.68
|
| Rate for Payer: Cofinity Commercial |
$205.67
|
| Rate for Payer: Healthscope Commercial |
$264.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.74
|
| Rate for Payer: PHP Commercial |
$249.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.67
|
| Rate for Payer: Priority Health SBD |
$185.10
|
|
|
HC CAST SHORT LEG
|
Facility
|
IP
|
$361.62
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$325.46 |
| Rate for Payer: Aetna Commercial |
$307.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.05
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$253.13
|
| Rate for Payer: Cofinity Commercial |
$310.99
|
| Rate for Payer: Healthscope Commercial |
$325.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.38
|
| Rate for Payer: PHP Commercial |
$307.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.13
|
| Rate for Payer: Priority Health SBD |
$227.82
|
|
|
HC CAST SHORT LEG
|
Facility
|
OP
|
$361.62
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$325.46 |
| Rate for Payer: Aetna Commercial |
$307.38
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$149.97
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$310.99
|
| Rate for Payer: Cofinity Commercial |
$253.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$325.46
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.38
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$307.38
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.13
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$227.82
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$57.96
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
