|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,458.07 |
| Max. Negotiated Rate |
$2,243.18 |
| Rate for Payer: Aetna Commercial |
$2,018.86
|
| Rate for Payer: ASR ASR |
$2,175.88
|
| Rate for Payer: ASR Commercial |
$2,175.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.97
|
| Rate for Payer: BCN Commercial |
$1,739.14
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$2,108.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,243.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,175.88
|
| Rate for Payer: Mclaren Commercial |
$2,018.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.00
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$320.34
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$288.31
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$310.73
|
| Rate for Payer: ASR Commercial |
$310.73
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$262.33
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cofinity Commercial |
$301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Healthscope Whirlpool |
$310.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$288.31
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$262.68
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.68
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$224.56
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$320.34
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.22 |
| Max. Negotiated Rate |
$320.34 |
| Rate for Payer: Aetna Commercial |
$288.31
|
| Rate for Payer: ASR ASR |
$310.73
|
| Rate for Payer: ASR Commercial |
$310.73
|
| Rate for Payer: BCBS Trust/PPO |
$261.05
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cofinity Commercial |
$301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.27
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Healthscope Whirlpool |
$310.73
|
| Rate for Payer: Mclaren Commercial |
$288.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$262.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.90
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,290.10
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,738.56 |
| Max. Negotiated Rate |
$7,290.10 |
| Rate for Payer: Aetna Commercial |
$6,561.09
|
| Rate for Payer: ASR ASR |
$7,071.40
|
| Rate for Payer: ASR Commercial |
$7,071.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,940.70
|
| Rate for Payer: BCN Commercial |
$5,652.01
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cofinity Commercial |
$6,852.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.08
|
| Rate for Payer: Healthscope Commercial |
$7,290.10
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.40
|
| Rate for Payer: Mclaren Commercial |
$6,561.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,196.59
|
| Rate for Payer: Nomi Health Commercial |
$5,977.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.29
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,290.10
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$8,171.71 |
| Rate for Payer: Aetna Commercial |
$6,561.09
|
| Rate for Payer: Aetna Medicare |
$5,272.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: ASR ASR |
$7,071.40
|
| Rate for Payer: ASR Commercial |
$7,071.40
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,969.86
|
| Rate for Payer: BCN Commercial |
$5,652.01
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cofinity Commercial |
$6,852.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Healthscope Commercial |
$7,290.10
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,272.07
|
| Rate for Payer: Mclaren Commercial |
$6,561.09
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,196.59
|
| Rate for Payer: Nomi Health Commercial |
$5,977.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Commercial |
$5,799.28
|
| Rate for Payer: PHP Medicaid |
$2,825.83
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,387.59
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Priority Health Narrow Network |
$5,110.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$8,171.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP DNSP |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$208.71 |
| Max. Negotiated Rate |
$321.09 |
| Rate for Payer: Aetna Commercial |
$288.98
|
| Rate for Payer: ASR ASR |
$311.46
|
| Rate for Payer: ASR Commercial |
$311.46
|
| Rate for Payer: BCBS Trust/PPO |
$261.66
|
| Rate for Payer: BCN Commercial |
$248.94
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Healthscope Commercial |
$321.09
|
| Rate for Payer: Healthscope Whirlpool |
$311.46
|
| Rate for Payer: Mclaren Commercial |
$288.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.56
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$321.09 |
| Rate for Payer: Aetna Commercial |
$288.98
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$311.46
|
| Rate for Payer: ASR Commercial |
$311.46
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$262.94
|
| Rate for Payer: BCN Commercial |
$248.94
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$321.09
|
| Rate for Payer: Healthscope Whirlpool |
$311.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$288.98
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.34
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$225.08
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$368.10 |
| Max. Negotiated Rate |
$566.31 |
| Rate for Payer: Aetna Commercial |
$509.68
|
| Rate for Payer: ASR ASR |
$549.32
|
| Rate for Payer: ASR Commercial |
$549.32
|
| Rate for Payer: BCBS Trust/PPO |
$461.49
|
| Rate for Payer: BCN Commercial |
$439.06
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$532.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Healthscope Commercial |
$566.31
|
| Rate for Payer: Healthscope Whirlpool |
$549.32
|
| Rate for Payer: Mclaren Commercial |
$509.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.35
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$566.31 |
| Rate for Payer: Aetna Commercial |
$509.68
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$549.32
|
| Rate for Payer: ASR Commercial |
$549.32
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$463.75
|
| Rate for Payer: BCN Commercial |
$439.06
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$532.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$566.31
|
| Rate for Payer: Healthscope Whirlpool |
$549.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$509.68
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.20
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$396.98
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,730.60 |
| Max. Negotiated Rate |
$4,200.93 |
| Rate for Payer: Aetna Commercial |
$3,780.84
|
| Rate for Payer: ASR ASR |
$4,074.90
|
| Rate for Payer: ASR Commercial |
$4,074.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,423.34
|
| Rate for Payer: BCN Commercial |
$3,256.98
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,948.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Healthscope Commercial |
$4,200.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,074.90
|
| Rate for Payer: Mclaren Commercial |
$3,780.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,696.82
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$3,780.84
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$4,074.90
|
| Rate for Payer: ASR Commercial |
$4,074.90
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,440.14
|
| Rate for Payer: BCN Commercial |
$3,256.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,948.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,200.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,074.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$3,780.84
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,680.85
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,944.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,696.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$140.24 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$140.24 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$114.84
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.88
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$98.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$114.84
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.88
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$98.31
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$140.24 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$396.97 |
| Rate for Payer: Aetna Commercial |
$357.27
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$385.06
|
| Rate for Payer: ASR Commercial |
$385.06
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$325.08
|
| Rate for Payer: BCN Commercial |
$307.77
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$373.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$396.97
|
| Rate for Payer: Healthscope Whirlpool |
$385.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$357.27
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.83
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$278.28
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$258.03 |
| Max. Negotiated Rate |
$396.97 |
| Rate for Payer: Aetna Commercial |
$357.27
|
| Rate for Payer: ASR ASR |
$385.06
|
| Rate for Payer: ASR Commercial |
$385.06
|
| Rate for Payer: BCBS Trust/PPO |
$323.49
|
| Rate for Payer: BCN Commercial |
$307.77
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$373.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Healthscope Commercial |
$396.97
|
| Rate for Payer: Healthscope Whirlpool |
$385.06
|
| Rate for Payer: Mclaren Commercial |
$357.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.33
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$292.66
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.14
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$250.52
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.23
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$552.32 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$535.75
|
| Rate for Payer: ASR Commercial |
$535.75
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$452.29
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$519.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$552.32
|
| Rate for Payer: Healthscope Whirlpool |
$535.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$497.09
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.94
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$387.18
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$359.01 |
| Max. Negotiated Rate |
$552.32 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: ASR ASR |
$535.75
|
| Rate for Payer: ASR Commercial |
$535.75
|
| Rate for Payer: BCBS Trust/PPO |
$450.09
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$519.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Healthscope Commercial |
$552.32
|
| Rate for Payer: Healthscope Whirlpool |
$535.75
|
| Rate for Payer: Mclaren Commercial |
$497.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.04
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$232.11
|
| Rate for Payer: ASR Commercial |
$232.11
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$195.95
|
| Rate for Payer: BCN Commercial |
$185.52
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$239.29
|
| Rate for Payer: Healthscope Whirlpool |
$232.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.67
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$167.74
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$155.54 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: ASR ASR |
$232.11
|
| Rate for Payer: ASR Commercial |
$232.11
|
| Rate for Payer: BCBS Trust/PPO |
$195.00
|
| Rate for Payer: BCN Commercial |
$185.52
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$239.29
|
| Rate for Payer: Healthscope Whirlpool |
$232.11
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.58
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$339.98
|
| Rate for Payer: Aetna Medicare |
$153.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: ASR ASR |
$366.42
|
| Rate for Payer: ASR Commercial |
$366.42
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$309.34
|
| Rate for Payer: BCN Commercial |
$292.87
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$355.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$377.75
|
| Rate for Payer: Healthscope Whirlpool |
$366.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$339.98
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.75
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$169.28
|
| Rate for Payer: PHP Medicaid |
$82.49
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.98
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health Narrow Network |
$264.80
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$238.53
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP DNSP |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$245.54 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$339.98
|
| Rate for Payer: ASR ASR |
$366.42
|
| Rate for Payer: ASR Commercial |
$366.42
|
| Rate for Payer: BCBS Trust/PPO |
$307.83
|
| Rate for Payer: BCN Commercial |
$292.87
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$355.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Healthscope Commercial |
$377.75
|
| Rate for Payer: Healthscope Whirlpool |
$366.42
|
| Rate for Payer: Mclaren Commercial |
$339.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.42
|
|
