|
HC CAST SUP SHT ARM SPLINT ADULT PLST
|
Facility
|
IP
|
$10.20
|
|
| Hospital Charge Code |
27200359
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.38
|
| Rate for Payer: BCN Commercial |
$8.38
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.89
|
| Rate for Payer: Healthscope Whirlpool |
$10.20
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC CAST SUP SHT ARM SPLINT PED FBRGLS
|
Facility
|
OP
|
$28.65
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$25.79
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: ASR ASR |
$27.79
|
| Rate for Payer: BCBS Complete |
$11.46
|
| Rate for Payer: BCBS Trust/PPO |
$23.62
|
| Rate for Payer: BCN Commercial |
$23.62
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Healthscope Whirlpool |
$28.65
|
| Rate for Payer: Mclaren Commercial |
$25.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$23.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.10
|
| Rate for Payer: Priority Health Narrow Network |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.21
|
|
|
HC CAST SUP SHT ARM SPLINT PED FBRGLS
|
Facility
|
IP
|
$28.65
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$25.79
|
| Rate for Payer: ASR ASR |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$23.53
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Healthscope Whirlpool |
$28.65
|
| Rate for Payer: Mclaren Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$23.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.21
|
|
|
HC CAST SUP SHT ARM SPLINT PED PLST
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
27000713
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Mclaren Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.08
|
|
|
HC CAST SUP SHT ARM SPLINT PED PLST
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
27000713
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCN Commercial |
$13.19
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Mclaren Commercial |
$14.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.02
|
| Rate for Payer: Priority Health Narrow Network |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.08
|
|
|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
IP
|
$58.36
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.77 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$52.52
|
| Rate for Payer: ASR ASR |
$56.61
|
| Rate for Payer: BCBS Trust/PPO |
$47.93
|
| Rate for Payer: BCN Commercial |
$47.93
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cofinity Commercial |
$54.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Healthscope Whirlpool |
$58.36
|
| Rate for Payer: Mclaren Commercial |
$52.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.61
|
| Rate for Payer: Nomi Health Commercial |
$47.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.36
|
|
|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
OP
|
$58.36
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$52.52
|
| Rate for Payer: Aetna Medicare |
$21.59
|
| Rate for Payer: ASR ASR |
$56.61
|
| Rate for Payer: BCBS Complete |
$23.34
|
| Rate for Payer: BCBS Trust/PPO |
$48.12
|
| Rate for Payer: BCN Commercial |
$48.12
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cofinity Commercial |
$54.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.69
|
| Rate for Payer: Healthscope Commercial |
$56.61
|
| Rate for Payer: Healthscope Whirlpool |
$58.36
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$47.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.14
|
| Rate for Payer: Priority Health Narrow Network |
$40.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.36
|
|
|
HC CAST SUP SHT GAUNTLET PLST
|
Facility
|
OP
|
$34.68
|
|
| Hospital Charge Code |
27000710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.59
|
| Rate for Payer: BCN Commercial |
$28.59
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$33.64
|
| Rate for Payer: Healthscope Whirlpool |
$34.68
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.39
|
| Rate for Payer: Priority Health Narrow Network |
$24.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
|
HC CAST SUP SHT GAUNTLET PLST
|
Facility
|
IP
|
$34.68
|
|
| Hospital Charge Code |
27000710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: ASR ASR |
$33.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.48
|
| Rate for Payer: BCN Commercial |
$28.48
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$32.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$33.64
|
| Rate for Payer: Healthscope Whirlpool |
$34.68
|
| Rate for Payer: Mclaren Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.52
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$31.83
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$31.83
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.89
|
| Rate for Payer: Priority Health Narrow Network |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
OP
|
$26.53
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.25
|
| Rate for Payer: Priority Health Narrow Network |
$18.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$26.53
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$507.83
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$380.87 |
| Max. Negotiated Rate |
$507.83 |
| Rate for Payer: Aetna Commercial |
$457.05
|
| Rate for Payer: ASR ASR |
$492.60
|
| Rate for Payer: BCBS Trust/PPO |
$417.03
|
| Rate for Payer: BCN Commercial |
$417.03
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cofinity Commercial |
$477.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.26
|
| Rate for Payer: Healthscope Commercial |
$492.60
|
| Rate for Payer: Healthscope Whirlpool |
$507.83
|
| Rate for Payer: Mclaren Commercial |
$457.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$416.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.89
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$507.83
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$507.83 |
| Rate for Payer: Aetna Commercial |
$457.05
|
| Rate for Payer: Aetna Medicare |
$278.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: ASR ASR |
$492.60
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$418.71
|
| Rate for Payer: BCN Commercial |
$418.71
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cash Price |
$406.26
|
| Rate for Payer: Cofinity Commercial |
$477.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$492.60
|
| Rate for Payer: Healthscope Whirlpool |
$507.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$278.69
|
| Rate for Payer: Mclaren Commercial |
$457.05
|
| Rate for Payer: Mclaren Medicaid |
$278.69
|
| 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 |
$153.06
|
| 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 |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$416.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.87
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$306.56
|
| Rate for Payer: PHP Medicaid |
$149.38
|
| 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/Tiered Network |
$444.96
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health Narrow Network |
$355.99
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$431.97
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP DNSP |
$278.69
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$365.82
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$365.82 |
| Rate for Payer: Aetna Commercial |
$329.24
|
| Rate for Payer: ASR ASR |
$354.85
|
| Rate for Payer: BCBS Trust/PPO |
$300.41
|
| Rate for Payer: BCN Commercial |
$300.41
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cofinity Commercial |
$343.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.66
|
| Rate for Payer: Healthscope Commercial |
$354.85
|
| Rate for Payer: Healthscope Whirlpool |
$365.82
|
| Rate for Payer: Mclaren Commercial |
$329.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.95
|
| Rate for Payer: Nomi Health Commercial |
$299.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.92
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$365.82
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$431.97 |
| Rate for Payer: Aetna Commercial |
$329.24
|
| Rate for Payer: Aetna Medicare |
$278.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.36
|
| Rate for Payer: ASR ASR |
$354.85
|
| Rate for Payer: BCBS Complete |
$153.06
|
| Rate for Payer: BCBS MAPPO |
$278.69
|
| Rate for Payer: BCBS Trust/PPO |
$301.62
|
| Rate for Payer: BCN Commercial |
$301.62
|
| Rate for Payer: BCN Medicare Advantage |
$278.69
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cofinity Commercial |
$343.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.69
|
| Rate for Payer: Healthscope Commercial |
$354.85
|
| Rate for Payer: Healthscope Whirlpool |
$365.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$278.69
|
| Rate for Payer: Mclaren Commercial |
$329.24
|
| Rate for Payer: Mclaren Medicaid |
$278.69
|
| 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 |
$153.06
|
| 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 |
$310.95
|
| Rate for Payer: Nomi Health Commercial |
$299.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.37
|
| Rate for Payer: PACE Medicare |
$264.76
|
| Rate for Payer: PACE SWMI |
$278.69
|
| Rate for Payer: PHP Commercial |
$306.56
|
| Rate for Payer: PHP Medicaid |
$149.38
|
| 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/Tiered Network |
$320.53
|
| Rate for Payer: Priority Health Medicare |
$278.69
|
| Rate for Payer: Priority Health Narrow Network |
$256.44
|
| Rate for Payer: Railroad Medicare Medicare |
$278.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.69
|
| Rate for Payer: UHC Exchange |
$431.97
|
| Rate for Payer: UHC Medicaid |
$145.75
|
| Rate for Payer: UHCCP DNSP |
$278.69
|
| Rate for Payer: UHCCP Medicaid |
$145.75
|
| Rate for Payer: VA VA |
$278.69
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$197.79
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna Commercial |
$178.01
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$191.86
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$163.08
|
| Rate for Payer: BCN Commercial |
$163.08
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Commercial |
$185.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$191.86
|
| Rate for Payer: Healthscope Whirlpool |
$197.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$178.01
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Nomi Health Commercial |
$162.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$173.30
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$138.65
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$197.79
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$148.34 |
| Max. Negotiated Rate |
$197.79 |
| Rate for Payer: Aetna Commercial |
$178.01
|
| Rate for Payer: ASR ASR |
$191.86
|
| Rate for Payer: BCBS Trust/PPO |
$162.43
|
| Rate for Payer: BCN Commercial |
$162.43
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Commercial |
$185.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Healthscope Commercial |
$191.86
|
| Rate for Payer: Healthscope Whirlpool |
$197.79
|
| Rate for Payer: Mclaren Commercial |
$178.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Nomi Health Commercial |
$162.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.06
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$61.55
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: ASR ASR |
$59.70
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$50.54
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Commercial |
$57.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Healthscope Commercial |
$59.70
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: Nomi Health Commercial |
$50.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.16
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$61.55
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: ASR ASR |
$59.70
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.75
|
| Rate for Payer: BCN Commercial |
$50.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Commercial |
$57.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$59.70
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$25.25
|
| Rate for Payer: Mclaren Medicare |
$25.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: Nomi Health Commercial |
$50.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.16
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$27.77
|
| Rate for Payer: PHP Medicaid |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.25
|
| Rate for Payer: UHC Exchange |
$39.14
|
| Rate for Payer: UHC Medicaid |
$13.21
|
| Rate for Payer: UHCCP DNSP |
$25.25
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: ASR ASR |
$57.23
|
| Rate for Payer: BCBS Trust/PPO |
$48.45
|
| Rate for Payer: BCN Commercial |
$48.45
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$55.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$57.23
|
| Rate for Payer: Healthscope Whirlpool |
$59.00
|
| Rate for Payer: Mclaren Commercial |
$53.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Nomi Health Commercial |
$48.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.92
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: ASR ASR |
$57.23
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$48.65
|
| Rate for Payer: BCN Commercial |
$48.65
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$55.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$57.23
|
| Rate for Payer: Healthscope Whirlpool |
$59.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.30
|
| Rate for Payer: Mclaren Commercial |
$53.10
|
| Rate for Payer: Mclaren Medicaid |
$27.30
|
| Rate for Payer: Mclaren Medicare |
$27.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.15
|
| Rate for Payer: Nomi Health Commercial |
$48.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PACE Medicare |
$25.93
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$30.03
|
| Rate for Payer: PHP Medicaid |
$14.63
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.70
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow Network |
$41.36
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.30
|
| Rate for Payer: UHC Exchange |
$42.31
|
| Rate for Payer: UHC Medicaid |
$14.28
|
| Rate for Payer: UHCCP DNSP |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$14.28
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: ASR ASR |
$72.06
|
| Rate for Payer: BCBS Trust/PPO |
$61.01
|
| Rate for Payer: BCN Commercial |
$61.01
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$72.06
|
| Rate for Payer: Healthscope Whirlpool |
$74.29
|
| Rate for Payer: Mclaren Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.38
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$72.06
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$61.25
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$72.06
|
| Rate for Payer: Healthscope Whirlpool |
$74.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.09
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$52.08
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
