|
HC CAST REPAIR
|
Facility
|
OP
|
$178.81
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$178.81 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Aetna Medicare |
$89.41
|
| Rate for Payer: ASR ASR |
$173.45
|
| Rate for Payer: ASR Commercial |
$173.45
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: BCBS Trust/PPO |
$146.43
|
| Rate for Payer: BCN Commercial |
$138.63
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cofinity Commercial |
$168.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.05
|
| Rate for Payer: Healthscope Commercial |
$178.81
|
| Rate for Payer: Healthscope Whirlpool |
$173.45
|
| Rate for Payer: Mclaren Commercial |
$160.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.99
|
| Rate for Payer: Nomi Health Commercial |
$146.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.67
|
| Rate for Payer: Priority Health Narrow Network |
$125.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.35
|
|
|
HC CAST REPAIR
|
Facility
|
IP
|
$178.81
|
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.23 |
| Max. Negotiated Rate |
$178.81 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: ASR ASR |
$173.45
|
| Rate for Payer: ASR Commercial |
$173.45
|
| Rate for Payer: BCBS Trust/PPO |
$145.71
|
| Rate for Payer: BCN Commercial |
$138.63
|
| Rate for Payer: Cash Price |
$143.05
|
| Rate for Payer: Cofinity Commercial |
$168.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.05
|
| Rate for Payer: Healthscope Commercial |
$178.81
|
| Rate for Payer: Healthscope Whirlpool |
$173.45
|
| Rate for Payer: Mclaren Commercial |
$160.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.99
|
| Rate for Payer: Nomi Health Commercial |
$146.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.35
|
|
|
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 |
$401.47 |
| Rate for Payer: Aetna Commercial |
$278.44
|
| Rate for Payer: Aetna Medicare |
$259.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: ASR ASR |
$300.10
|
| Rate for Payer: ASR Commercial |
$300.10
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCBS Trust/PPO |
$253.35
|
| Rate for Payer: BCN Commercial |
$239.86
|
| 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 |
$290.82
|
| 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 |
$309.38
|
| Rate for Payer: Healthscope Whirlpool |
$300.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$259.01
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$253.69
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$284.91
|
| Rate for Payer: PHP Medicaid |
$138.83
|
| 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 HMO/PPO/Tiered Network |
$271.08
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health Narrow Network |
$216.88
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Exchange |
$401.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP DNSP |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$138.83
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST RISSER BODY ONLY
|
Facility
|
IP
|
$309.38
|
|
|
Service Code
|
CPT 29010
|
| Hospital Charge Code |
70000001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$201.10 |
| Max. Negotiated Rate |
$309.38 |
| Rate for Payer: Aetna Commercial |
$278.44
|
| Rate for Payer: ASR ASR |
$300.10
|
| Rate for Payer: ASR Commercial |
$300.10
|
| Rate for Payer: BCBS Trust/PPO |
$252.11
|
| Rate for Payer: BCN Commercial |
$239.86
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$290.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$309.38
|
| Rate for Payer: Healthscope Whirlpool |
$300.10
|
| Rate for Payer: Mclaren Commercial |
$278.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: Nomi Health Commercial |
$253.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.25
|
|
|
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 |
$401.47 |
| Rate for Payer: Aetna Commercial |
$270.16
|
| Rate for Payer: Aetna Medicare |
$259.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: ASR ASR |
$291.17
|
| Rate for Payer: ASR Commercial |
$291.17
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCBS Trust/PPO |
$245.82
|
| Rate for Payer: BCN Commercial |
$232.73
|
| 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 |
$282.17
|
| 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 |
$300.18
|
| Rate for Payer: Healthscope Whirlpool |
$291.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$259.01
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$246.15
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$284.91
|
| Rate for Payer: PHP Medicaid |
$138.83
|
| 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 HMO/PPO/Tiered Network |
$263.02
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health Narrow Network |
$210.43
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Exchange |
$401.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP DNSP |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$138.83
|
| 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 |
$195.12 |
| Max. Negotiated Rate |
$300.18 |
| Rate for Payer: Aetna Commercial |
$270.16
|
| Rate for Payer: ASR ASR |
$291.17
|
| Rate for Payer: ASR Commercial |
$291.17
|
| Rate for Payer: BCBS Trust/PPO |
$244.62
|
| Rate for Payer: BCN Commercial |
$232.73
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cofinity Commercial |
$282.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.14
|
| Rate for Payer: Healthscope Commercial |
$300.18
|
| Rate for Payer: Healthscope Whirlpool |
$291.17
|
| Rate for Payer: Mclaren Commercial |
$270.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.15
|
| Rate for Payer: Nomi Health Commercial |
$246.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.16
|
|
|
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 |
$401.47 |
| Rate for Payer: Aetna Commercial |
$331.96
|
| Rate for Payer: Aetna Medicare |
$259.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: ASR ASR |
$357.78
|
| Rate for Payer: ASR Commercial |
$357.78
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCBS Trust/PPO |
$302.05
|
| Rate for Payer: BCN Commercial |
$285.97
|
| 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 |
$346.72
|
| 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 |
$368.85
|
| Rate for Payer: Healthscope Whirlpool |
$357.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$259.01
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$302.46
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$284.91
|
| Rate for Payer: PHP Medicaid |
$138.83
|
| 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 HMO/PPO/Tiered Network |
$323.19
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health Narrow Network |
$258.56
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Exchange |
$401.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP DNSP |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$138.83
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST SHORT LEG
|
Facility
|
IP
|
$368.85
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
70000007
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$239.75 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$331.96
|
| Rate for Payer: ASR ASR |
$357.78
|
| Rate for Payer: ASR Commercial |
$357.78
|
| Rate for Payer: BCBS Trust/PPO |
$300.58
|
| Rate for Payer: BCN Commercial |
$285.97
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$346.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Healthscope Whirlpool |
$357.78
|
| Rate for Payer: Mclaren Commercial |
$331.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$302.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.59
|
|
|
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 |
$401.47 |
| Rate for Payer: Aetna Commercial |
$331.96
|
| Rate for Payer: Aetna Medicare |
$259.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: ASR ASR |
$357.78
|
| Rate for Payer: ASR Commercial |
$357.78
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCBS Trust/PPO |
$302.05
|
| Rate for Payer: BCN Commercial |
$285.97
|
| 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 |
$346.72
|
| 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 |
$368.85
|
| Rate for Payer: Healthscope Whirlpool |
$357.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$259.01
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$302.46
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$284.91
|
| Rate for Payer: PHP Medicaid |
$138.83
|
| 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 HMO/PPO/Tiered Network |
$323.19
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health Narrow Network |
$258.56
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Exchange |
$401.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP DNSP |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$138.83
|
| 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 |
$239.75 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$331.96
|
| Rate for Payer: ASR ASR |
$357.78
|
| Rate for Payer: ASR Commercial |
$357.78
|
| Rate for Payer: BCBS Trust/PPO |
$300.58
|
| Rate for Payer: BCN Commercial |
$285.97
|
| Rate for Payer: Cash Price |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$346.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.08
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Healthscope Whirlpool |
$357.78
|
| Rate for Payer: Mclaren Commercial |
$331.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$302.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.59
|
|
|
HC CAST SUP LNG ARM ADULT FBRGLS
|
Facility
|
IP
|
$57.22
|
|
| Hospital Charge Code |
27200327
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$57.22 |
| Rate for Payer: Aetna Commercial |
$51.50
|
| Rate for Payer: ASR ASR |
$55.50
|
| Rate for Payer: ASR Commercial |
$55.50
|
| Rate for Payer: BCBS Trust/PPO |
$46.63
|
| Rate for Payer: BCN Commercial |
$44.36
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$57.22
|
| Rate for Payer: Healthscope Whirlpool |
$55.50
|
| Rate for Payer: Mclaren Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.35
|
|
|
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 |
$57.22 |
| Rate for Payer: Aetna Commercial |
$51.50
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: ASR ASR |
$55.50
|
| Rate for Payer: ASR Commercial |
$55.50
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$46.86
|
| Rate for Payer: BCN Commercial |
$44.36
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$57.22
|
| Rate for Payer: Healthscope Whirlpool |
$55.50
|
| Rate for Payer: Mclaren Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.14
|
| Rate for Payer: Priority Health Narrow Network |
$40.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.35
|
|
|
HC CAST SUP LNG ARM PED FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
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 |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
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 |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC CAST SUP LNG ARM SPLINT ADULT PLST
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
27200392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: ASR ASR |
$41.71
|
| Rate for Payer: ASR Commercial |
$41.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.04
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$43.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.71
|
| Rate for Payer: Mclaren Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.84
|
|
|
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 |
$43.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: ASR ASR |
$41.71
|
| Rate for Payer: ASR Commercial |
$41.71
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.21
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$43.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.71
|
| Rate for Payer: Mclaren Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.68
|
| Rate for Payer: Priority Health Narrow Network |
$30.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.84
|
|
|
HC CAST SUP LNG ARM SPLNT PED FBRGLS
|
Facility
|
IP
|
$24.97
|
|
| Hospital Charge Code |
27200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: ASR Commercial |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.35
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.22
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
|
|
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 |
$24.97 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: ASR Commercial |
$24.22
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.45
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.22
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.88
|
| Rate for Payer: Priority Health Narrow Network |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
|
|
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 |
$118.61 |
| Rate for Payer: Aetna Commercial |
$106.75
|
| Rate for Payer: Aetna Medicare |
$59.30
|
| Rate for Payer: ASR ASR |
$115.05
|
| Rate for Payer: ASR Commercial |
$115.05
|
| Rate for Payer: BCBS Complete |
$47.44
|
| Rate for Payer: BCBS Trust/PPO |
$97.13
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$118.61
|
| Rate for Payer: Healthscope Whirlpool |
$115.05
|
| Rate for Payer: Mclaren Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.93
|
| Rate for Payer: Priority Health Narrow Network |
$83.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.38
|
|
|
HC CAST SUP LNG LEG ADULT FBRGLS
|
Facility
|
IP
|
$118.61
|
|
| Hospital Charge Code |
27200336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$118.61 |
| Rate for Payer: Aetna Commercial |
$106.75
|
| Rate for Payer: ASR ASR |
$115.05
|
| Rate for Payer: ASR Commercial |
$115.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.66
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$118.61
|
| Rate for Payer: Healthscope Whirlpool |
$115.05
|
| Rate for Payer: Mclaren Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.38
|
|
|
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 |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC CAST SUP LNG LEG CYLNDR PED FBRGLS
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
27200338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC CAST SUP LNG LEG PED FBRGLS
|
Facility
|
IP
|
$54.10
|
|
| Hospital Charge Code |
27200337
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: ASR ASR |
$52.48
|
| Rate for Payer: ASR Commercial |
$52.48
|
| Rate for Payer: BCBS Trust/PPO |
$44.09
|
| Rate for Payer: BCN Commercial |
$41.94
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$50.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Healthscope Whirlpool |
$52.48
|
| Rate for Payer: Mclaren Commercial |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.61
|
|
