|
HC CAST GAUNTLET
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
42100002
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$202.42
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: Cofinity Commercial |
$166.70
|
| Rate for Payer: Cofinity Commercial |
$204.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$214.33
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.42
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$202.42
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.79
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$150.03
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Core |
$176.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$176.22
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC CAST HIP SPICA 1 AND 1 HALF OR BOTH
|
Facility
|
IP
|
$969.55
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
70000004
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$610.82 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$824.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.21
|
| Rate for Payer: Cash Price |
$775.64
|
| Rate for Payer: Cofinity Commercial |
$678.68
|
| Rate for Payer: Cofinity Commercial |
$833.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.64
|
| Rate for Payer: Healthscope Commercial |
$872.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.12
|
| Rate for Payer: PHP Commercial |
$824.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.21
|
| Rate for Payer: Priority Health SBD |
$610.82
|
|
|
HC CAST HIP SPICA 1 AND 1 HALF OR BOTH
|
Facility
|
OP
|
$969.55
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
70000004
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$824.12
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$775.64
|
| Rate for Payer: Cash Price |
$775.64
|
| Rate for Payer: Cofinity Commercial |
$833.81
|
| Rate for Payer: Cofinity Commercial |
$678.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$872.60
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.12
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$824.12
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.21
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$610.82
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST LONG ARM
|
Facility
|
IP
|
$341.68
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
42100001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$215.26 |
| Max. Negotiated Rate |
$307.51 |
| Rate for Payer: Aetna Commercial |
$290.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.09
|
| Rate for Payer: Cash Price |
$273.34
|
| Rate for Payer: Cofinity Commercial |
$239.18
|
| Rate for Payer: Cofinity Commercial |
$293.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.34
|
| Rate for Payer: Healthscope Commercial |
$307.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.43
|
| Rate for Payer: PHP Commercial |
$290.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.09
|
| Rate for Payer: Priority Health SBD |
$215.26
|
|
|
HC CAST LONG ARM
|
Facility
|
OP
|
$341.68
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
42100001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$290.43
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$273.34
|
| Rate for Payer: Cash Price |
$273.34
|
| Rate for Payer: Cofinity Commercial |
$293.84
|
| Rate for Payer: Cofinity Commercial |
$239.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$307.51
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.43
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$290.43
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.09
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$215.26
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST LONG LEG
|
Facility
|
IP
|
$411.68
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$259.36 |
| Max. Negotiated Rate |
$370.51 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health SBD |
$259.36
|
|
|
HC CAST LONG LEG
|
Facility
|
OP
|
$411.68
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
70000005
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST PANTALOON
|
Facility
|
IP
|
$918.57
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
70000003
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$578.70 |
| Max. Negotiated Rate |
$826.71 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.07
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$643.00
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health SBD |
$578.70
|
|
|
HC CAST PANTALOON
|
Facility
|
OP
|
$918.57
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
70000003
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$826.71 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$643.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$578.70
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST PTB WALKING
|
Facility
|
IP
|
$411.68
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
70000009
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$259.36 |
| Max. Negotiated Rate |
$370.51 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health SBD |
$259.36
|
|
|
HC CAST PTB WALKING
|
Facility
|
OP
|
$411.68
|
|
|
Service Code
|
CPT 29435
|
| Hospital Charge Code |
70000009
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$288.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST REPAIR
|
Facility
|
OP
|
$178.81
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Aetna Commercial |
$151.99
|
| Rate for Payer: Aetna Medicare |
$89.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.23
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cofinity Commercial |
$125.17
|
| Rate for Payer: Cofinity Commercial |
$153.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.05
|
| Rate for Payer: Healthscope Commercial |
$160.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.99
|
| Rate for Payer: PHP Commercial |
$151.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.23
|
| Rate for Payer: Priority Health SBD |
$112.65
|
|
|
HC CAST REPAIR
|
Facility
|
IP
|
$178.81
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.65 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Aetna Commercial |
$151.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.23
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cofinity Commercial |
$125.17
|
| Rate for Payer: Cofinity Commercial |
$153.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.05
|
| Rate for Payer: Healthscope Commercial |
$160.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.99
|
| Rate for Payer: PHP Commercial |
$151.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.23
|
| Rate for Payer: Priority Health SBD |
$112.65
|
|
|
HC CAST RISSER BODY ONLY
|
Facility
|
IP
|
$309.38
|
|
|
Service Code
|
CPT 29010
|
| Hospital Charge Code |
70000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$194.91 |
| Max. Negotiated Rate |
$278.44 |
| Rate for Payer: Aetna Commercial |
$262.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$216.57
|
| Rate for Payer: Cofinity Commercial |
$266.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$278.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: PHP Commercial |
$262.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: Priority Health SBD |
$194.91
|
|
|
HC CAST RISSER BODY ONLY
|
Facility
|
OP
|
$309.38
|
|
|
Service Code
|
CPT 29010
|
| Hospital Charge Code |
70000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$262.97
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$216.57
|
| Rate for Payer: Cofinity Commercial |
$266.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$278.44
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$262.97
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$194.91
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST SHORT ARM
|
Facility
|
OP
|
$300.18
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$255.15
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cofinity Commercial |
$210.13
|
| Rate for Payer: Cofinity Commercial |
$258.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$270.16
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.15
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$255.15
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.12
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$189.11
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST SHORT ARM
|
Facility
|
IP
|
$300.18
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$189.11 |
| Max. Negotiated Rate |
$270.16 |
| Rate for Payer: Aetna Commercial |
$255.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.12
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cofinity Commercial |
$210.13
|
| Rate for Payer: Cofinity Commercial |
$258.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.14
|
| Rate for Payer: Healthscope Commercial |
$270.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.15
|
| Rate for Payer: PHP Commercial |
$255.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.12
|
| Rate for Payer: Priority Health SBD |
$189.11
|
|
|
HC CAST SHORT LEG
|
Facility
|
IP
|
$368.85
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$331.96 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$258.19
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health SBD |
$232.38
|
|
|
HC CAST SHORT LEG
|
Facility
|
OP
|
$368.85
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Commercial |
$258.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$232.38
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST SHORT LEG WALKING
|
Facility
|
OP
|
$368.85
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
70000008
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Commercial |
$258.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$232.38
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST SHORT LEG WALKING
|
Facility
|
IP
|
$368.85
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
70000008
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$331.96 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$258.19
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health SBD |
$232.38
|
|
|
HC CAST SUP LNG ARM ADULT FBRGLS
|
Facility
|
OP
|
$57.22
|
|
| Hospital Charge Code |
27200327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC CAST SUP LNG ARM ADULT FBRGLS
|
Facility
|
IP
|
$57.22
|
|
| Hospital Charge Code |
27200327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC CAST SUP LNG ARM PED FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST SUP LNG ARM PED FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
