|
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 |
$53.95 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$53.95
|
| Rate for Payer: BCN Commercial |
$53.95
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$329.34
|
| 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 |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.68
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
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 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 |
$89.40
|
| 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 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 |
$90.63 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$262.97
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.63
|
| Rate for Payer: BCN Commercial |
$90.63
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$266.07
|
| Rate for Payer: Cofinity Commercial |
$216.57
|
| 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 |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$278.44
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$262.97
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$194.91
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.38
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
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 ARM
|
Facility
|
OP
|
$300.18
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$65.90 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$255.15
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$93.50
|
| Rate for Payer: BCN Commercial |
$93.50
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$240.14
|
| 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 |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$270.16
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.15
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$255.15
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$189.11
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.90
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
HC CAST SHORT LEG
|
Facility
|
OP
|
$368.85
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$154.43
|
| Rate for Payer: BCN Commercial |
$154.43
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$295.08
|
| 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 |
$258.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$232.38
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.88
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
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 |
$258.20
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.20
|
| 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 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 |
$258.20
|
| Rate for Payer: Cofinity Commercial |
$317.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.20
|
| 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 WALKING
|
Facility
|
OP
|
$368.85
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
70000008
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$154.43
|
| Rate for Payer: BCN Commercial |
$154.43
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Cash Price |
$295.08
|
| 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 |
$258.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.21
|
| Rate for Payer: Healthscope Commercial |
$331.96
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Commercial |
$313.52
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Priority Health SBD |
$232.38
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.99
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$146.50
|
| Rate for Payer: VA VA |
$260.21
|
|
|
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 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 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
|
|
|
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 |
$13.00
|
| 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 SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200332
|
|
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
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200332
|
|
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 |
$13.00
|
| 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 SPLINT ADULT PLST
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
27200392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT PLST
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
27200392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
HC CAST SUP LNG ARM SPLNT PED FBRGLS
|
Facility
|
IP
|
$24.97
|
|
| Hospital Charge Code |
27200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC CAST SUP LNG ARM SPLNT PED FBRGLS
|
Facility
|
OP
|
$24.97
|
|
| Hospital Charge Code |
27200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC CAST SUP LNG LEG ADULT FBRGLS
|
Facility
|
OP
|
$118.61
|
|
| Hospital Charge Code |
27200336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: Aetna Medicare |
$59.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.10
|
| Rate for Payer: BCBS Complete |
$47.44
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$83.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health SBD |
$74.72
|
|
|
HC CAST SUP LNG LEG ADULT FBRGLS
|
Facility
|
IP
|
$118.61
|
|
| Hospital Charge Code |
27200336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.10
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$83.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health SBD |
$74.72
|
|
|
HC CAST SUP LNG LEG CYLNDR PED FBRGLS
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
27200338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
