|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health SBD |
$32.39
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health SBD |
$32.39
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$381.22 |
| Max. Negotiated Rate |
$1,300.21 |
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.48
|
| Rate for Payer: BCBS Complete |
$381.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.21
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Cofinity Commercial |
$667.13
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health SBD |
$600.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.91
|
| Rate for Payer: UHC Exchange |
$485.76
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.42 |
| Max. Negotiated Rate |
$857.74 |
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.48
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Cofinity Commercial |
$667.13
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health SBD |
$600.42
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.89
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health SBD |
$368.20
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$233.78 |
| Max. Negotiated Rate |
$839.49 |
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.89
|
| Rate for Payer: BCBS Complete |
$233.78
|
| Rate for Payer: BCBS Trust/PPO |
$839.49
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health SBD |
$368.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.41
|
| Rate for Payer: UHC Exchange |
$347.01
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.19 |
| Max. Negotiated Rate |
$2,065.60 |
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.68
|
| Rate for Payer: BCBS Complete |
$575.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,065.60
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Cofinity Commercial |
$1,006.58
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health SBD |
$905.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.72
|
| Rate for Payer: UHC Exchange |
$813.10
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$905.92 |
| Max. Negotiated Rate |
$1,294.17 |
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.68
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,006.58
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health SBD |
$905.92
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.17
|
| Rate for Payer: BCBS Complete |
$129.34
|
| Rate for Payer: BCBS Trust/PPO |
$441.09
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health SBD |
$203.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.19
|
| Rate for Payer: UHC Exchange |
$207.66
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$291.01 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.17
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health SBD |
$203.70
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.44
|
| Rate for Payer: BCBS Complete |
$51.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Cofinity Commercial |
$90.93
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health SBD |
$81.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Exchange |
$14.39
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.44
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Cofinity Commercial |
$90.93
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health SBD |
$81.84
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.70 |
| Max. Negotiated Rate |
$1,321.00 |
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.06
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.45
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health SBD |
$924.70
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.11 |
| Max. Negotiated Rate |
$2,071.07 |
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.06
|
| Rate for Payer: BCBS Complete |
$587.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.07
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Cofinity Commercial |
$1,027.45
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health SBD |
$924.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.62
|
| Rate for Payer: UHC Exchange |
$852.18
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.96
|
| Rate for Payer: BCBS Complete |
$57.82
|
| Rate for Payer: BCBS Trust/PPO |
$322.42
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Cofinity Commercial |
$101.18
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health SBD |
$91.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.34
|
| Rate for Payer: UHC Exchange |
$131.12
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.96
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$101.18
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health SBD |
$91.07
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.11 |
| Max. Negotiated Rate |
$301.59 |
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.82
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$234.57
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health SBD |
$211.11
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$471.94 |
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.82
|
| Rate for Payer: BCBS Complete |
$134.04
|
| Rate for Payer: BCBS Trust/PPO |
$471.94
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$234.57
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health SBD |
$211.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.49
|
| Rate for Payer: UHC Exchange |
$186.24
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$69.65
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.47
|
| Rate for Payer: UHC Exchange |
$30.39
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.21
|
| Rate for Payer: BCBS Complete |
$37.67
|
| Rate for Payer: BCBS Trust/PPO |
$22.14
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$65.92
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health SBD |
$59.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.52
|
| Rate for Payer: UHC Exchange |
$10.43
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.21
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$65.92
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health SBD |
$59.33
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,099.28
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$439.71 |
| Max. Negotiated Rate |
$1,579.02 |
| Rate for Payer: Aetna Commercial |
$934.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.53
|
| Rate for Payer: BCBS Complete |
$439.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.02
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cofinity Commercial |
$769.50
|
| Rate for Payer: Cofinity Commercial |
$945.38
|
| Rate for Payer: Healthscope Commercial |
$989.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$934.39
|
| Rate for Payer: PHP Commercial |
$934.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.50
|
| Rate for Payer: Priority Health SBD |
$692.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.04
|
| Rate for Payer: UHC Exchange |
$636.70
|
|
