|
HC CAST SHORT ARM
|
Facility
|
IP
|
$306.18
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$192.89 |
| Max. Negotiated Rate |
$275.56 |
| Rate for Payer: Aetna Commercial |
$260.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.02
|
| Rate for Payer: Cash Price |
$244.94
|
| Rate for Payer: Cofinity Advantage |
$214.33
|
| Rate for Payer: Cofinity Commercial |
$263.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.94
|
| Rate for Payer: Healthscope Commercial |
$275.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.63
|
| Rate for Payer: PHP Commercial |
$260.25
|
| Rate for Payer: Priority Health SBD |
$192.89
|
|
|
HC CAST SHORT ARM
|
Facility
|
OP
|
$306.18
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$901.26 |
| Rate for Payer: Aetna Commercial |
$260.25
|
| Rate for Payer: Aetna Medicare |
$289.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$119.77
|
| Rate for Payer: BCN Commercial |
$119.77
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$244.94
|
| Rate for Payer: Cash Price |
$244.94
|
| Rate for Payer: Cash Price |
$244.94
|
| Rate for Payer: Cofinity Advantage |
$214.33
|
| Rate for Payer: Cofinity Commercial |
$263.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$275.56
|
| Rate for Payer: Mclaren Medicaid |
$145.75
|
| Rate for Payer: Mclaren Medicare |
$278.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.62
|
| Rate for Payer: Meridian Medicaid |
$292.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.25
|
| Rate for Payer: Nomi Health Commercial |
$836.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.63
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$260.25
|
| Rate for Payer: PHP Medicare Advantage |
$278.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$901.26
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health SBD |
$192.89
|
| Rate for Payer: Priority Health Tiered Network |
$721.01
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.02
|
| Rate for Payer: UHC Core |
$159.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$120.33
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST SHORT LEG
|
Facility
|
IP
|
$376.23
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$338.61 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.55
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cofinity Advantage |
$263.36
|
| Rate for Payer: Cofinity Commercial |
$323.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.98
|
| Rate for Payer: Healthscope Commercial |
$338.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.17
|
| Rate for Payer: PHP Commercial |
$319.80
|
| Rate for Payer: Priority Health SBD |
$237.02
|
|
|
HC CAST SHORT LEG
|
Facility
|
OP
|
$376.23
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$901.26 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna Medicare |
$289.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$197.81
|
| Rate for Payer: BCN Commercial |
$197.81
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cofinity Advantage |
$263.36
|
| Rate for Payer: Cofinity Commercial |
$323.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$338.61
|
| Rate for Payer: Mclaren Medicaid |
$145.75
|
| Rate for Payer: Mclaren Medicare |
$278.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.62
|
| Rate for Payer: Meridian Medicaid |
$292.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.80
|
| Rate for Payer: Nomi Health Commercial |
$836.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.17
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$319.80
|
| Rate for Payer: PHP Medicare Advantage |
$278.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$901.26
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health SBD |
$237.02
|
| Rate for Payer: Priority Health Tiered Network |
$721.01
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.55
|
| Rate for Payer: UHC Core |
$196.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$147.86
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST SHORT LEG WALKING
|
Facility
|
OP
|
$376.23
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
70000008
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$901.26 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna Medicare |
$289.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$197.81
|
| Rate for Payer: BCN Commercial |
$197.81
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cofinity Advantage |
$263.36
|
| Rate for Payer: Cofinity Commercial |
$323.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$338.61
|
| Rate for Payer: Mclaren Medicaid |
$145.75
|
| Rate for Payer: Mclaren Medicare |
$278.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.62
|
| Rate for Payer: Meridian Medicaid |
$292.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.80
|
| Rate for Payer: Nomi Health Commercial |
$836.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.17
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$319.80
|
| Rate for Payer: PHP Medicare Advantage |
$278.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$901.26
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health SBD |
$237.02
|
| Rate for Payer: Priority Health Tiered Network |
$721.01
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.55
|
| Rate for Payer: UHC Core |
$196.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$147.86
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST SHORT LEG WALKING
|
Facility
|
IP
|
$376.23
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
70000008
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$338.61 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.55
|
| Rate for Payer: Cash Price |
$300.98
|
| Rate for Payer: Cofinity Advantage |
$263.36
|
| Rate for Payer: Cofinity Commercial |
$323.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.98
|
| Rate for Payer: Healthscope Commercial |
$338.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.17
|
| Rate for Payer: PHP Commercial |
$319.80
|
| Rate for Payer: Priority Health SBD |
$237.02
|
|
|
HC CAST SUP LNG ARM ADULT FBRGLS
|
Facility
|
OP
|
$58.36
|
|
| Hospital Charge Code |
27200327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Medicare |
$29.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.93
|
| Rate for Payer: BCBS Complete |
$23.34
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cofinity Advantage |
$40.85
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Healthscope Commercial |
$52.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: PHP Commercial |
$49.61
|
| Rate for Payer: Priority Health SBD |
$36.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.93
|
| Rate for Payer: UHC Core |
$30.41
|
| Rate for Payer: UHC Exchange |
$22.94
|
|
|
HC CAST SUP LNG ARM ADULT FBRGLS
|
Facility
|
IP
|
$58.36
|
|
| Hospital Charge Code |
27200327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$52.52 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.93
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cofinity Advantage |
$40.85
|
| Rate for Payer: Cofinity Commercial |
$50.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Healthscope Commercial |
$52.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: PHP Commercial |
$49.61
|
| Rate for Payer: Priority Health SBD |
$36.77
|
|
|
HC CAST SUP LNG ARM PED FBRGLS
|
Facility
|
OP
|
$26.53
|
|
| Hospital Charge Code |
27200328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.24
|
| Rate for Payer: UHC Core |
$13.82
|
| Rate for Payer: UHC Exchange |
$10.43
|
|
|
HC CAST SUP LNG ARM PED FBRGLS
|
Facility
|
IP
|
$26.53
|
|
| Hospital Charge Code |
27200328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$26.53
|
|
| Hospital Charge Code |
27200332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$26.53
|
|
| Hospital Charge Code |
27200332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.24
|
| Rate for Payer: UHC Core |
$13.82
|
| Rate for Payer: UHC Exchange |
$10.43
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT PLST
|
Facility
|
OP
|
$43.86
|
|
| Hospital Charge Code |
27200392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Advantage |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.90
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.51
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: UHC Exchange |
$17.24
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT PLST
|
Facility
|
IP
|
$43.86
|
|
| Hospital Charge Code |
27200392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Advantage |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.90
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC CAST SUP LNG ARM SPLNT PED FBRGLS
|
Facility
|
OP
|
$25.47
|
|
| Hospital Charge Code |
27200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.56
|
| Rate for Payer: UHC Core |
$13.27
|
| Rate for Payer: UHC Exchange |
$10.01
|
|
|
HC CAST SUP LNG ARM SPLNT PED FBRGLS
|
Facility
|
IP
|
$25.47
|
|
| Hospital Charge Code |
27200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
|
|
HC CAST SUP LNG LEG ADULT FBRGLS
|
Facility
|
OP
|
$120.98
|
|
| Hospital Charge Code |
27200336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$108.88 |
| Rate for Payer: Aetna Commercial |
$102.83
|
| Rate for Payer: Aetna Medicare |
$60.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.64
|
| Rate for Payer: BCBS Complete |
$48.39
|
| Rate for Payer: Cash Price |
$96.78
|
| Rate for Payer: Cofinity Advantage |
$84.69
|
| Rate for Payer: Cofinity Commercial |
$104.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.78
|
| Rate for Payer: Healthscope Commercial |
$108.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.73
|
| Rate for Payer: PHP Commercial |
$102.83
|
| Rate for Payer: Priority Health SBD |
$76.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.64
|
| Rate for Payer: UHC Core |
$63.03
|
| Rate for Payer: UHC Exchange |
$47.55
|
|
|
HC CAST SUP LNG LEG ADULT FBRGLS
|
Facility
|
IP
|
$120.98
|
|
| Hospital Charge Code |
27200336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$108.88 |
| Rate for Payer: Aetna Commercial |
$102.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.64
|
| Rate for Payer: Cash Price |
$96.78
|
| Rate for Payer: Cofinity Advantage |
$84.69
|
| Rate for Payer: Cofinity Commercial |
$104.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.78
|
| Rate for Payer: Healthscope Commercial |
$108.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.73
|
| Rate for Payer: PHP Commercial |
$102.83
|
| Rate for Payer: Priority Health SBD |
$76.22
|
|
|
HC CAST SUP LNG LEG CYLNDR PED FBRGLS
|
Facility
|
OP
|
$53.06
|
|
| Hospital Charge Code |
27200338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Exchange |
$20.85
|
|
|
HC CAST SUP LNG LEG CYLNDR PED FBRGLS
|
Facility
|
IP
|
$53.06
|
|
| Hospital Charge Code |
27200338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC CAST SUP LNG LEG PED FBRGLS
|
Facility
|
IP
|
$55.18
|
|
| Hospital Charge Code |
27200337
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health SBD |
$34.76
|
|
|
HC CAST SUP LNG LEG PED FBRGLS
|
Facility
|
OP
|
$55.18
|
|
| Hospital Charge Code |
27200337
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: BCBS Complete |
$22.07
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health SBD |
$34.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.87
|
| Rate for Payer: UHC Core |
$28.75
|
| Rate for Payer: UHC Exchange |
$21.69
|
|
|
HC CAST SUP LNG LEG SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$78.03
|
|
| Hospital Charge Code |
27200381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: BCBS Complete |
$31.21
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.72
|
| Rate for Payer: UHC Core |
$40.65
|
| Rate for Payer: UHC Exchange |
$30.67
|
|
|
HC CAST SUP LNG LEG SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$78.03
|
|
| Hospital Charge Code |
27200381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC CAST SUP LNG LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$39.54
|
|
| Hospital Charge Code |
27200382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Advantage |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.66
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health SBD |
$24.91
|
|
