HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,099.28
|
|
Service Code
|
HCPCS L5450
|
Hospital Charge Code |
27000013
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$692.55 |
Max. Negotiated Rate |
$989.35 |
Rate for Payer: Aetna Commercial |
$934.39
|
Rate for Payer: Aetna New Business (MI Preferred) |
$714.53
|
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
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,234.33
|
|
Service Code
|
HCPCS L0190
|
Hospital Charge Code |
27000014
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$777.63 |
Max. Negotiated Rate |
$1,110.90 |
Rate for Payer: Aetna Commercial |
$1,049.18
|
Rate for Payer: Aetna New Business (MI Preferred) |
$802.31
|
Rate for Payer: Cash Price |
$987.46
|
Rate for Payer: Cofinity Commercial |
$1,061.52
|
Rate for Payer: Cofinity Commercial |
$864.03
|
Rate for Payer: Healthscope Commercial |
$1,110.90
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
Rate for Payer: PHP Commercial |
$1,049.18
|
Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
Rate for Payer: Priority Health SBD |
$777.63
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,234.33
|
|
Service Code
|
HCPCS L0190
|
Hospital Charge Code |
27000014
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$493.73 |
Max. Negotiated Rate |
$1,773.06 |
Rate for Payer: Aetna Commercial |
$1,049.18
|
Rate for Payer: Aetna New Business (MI Preferred) |
$802.31
|
Rate for Payer: BCBS Complete |
$493.73
|
Rate for Payer: BCBS Trust/PPO |
$1,773.06
|
Rate for Payer: Cash Price |
$987.46
|
Rate for Payer: Cash Price |
$987.46
|
Rate for Payer: Cofinity Commercial |
$1,061.52
|
Rate for Payer: Cofinity Commercial |
$864.03
|
Rate for Payer: Healthscope Commercial |
$1,110.90
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
Rate for Payer: PHP Commercial |
$1,049.18
|
Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
Rate for Payer: Priority Health SBD |
$777.63
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$871.98
|
Rate for Payer: UHC Exchange |
$726.65
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,050.00
|
|
Service Code
|
HCPCS L1499
|
Hospital Charge Code |
27400030
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$420.00 |
Max. Negotiated Rate |
$1,378.38 |
Rate for Payer: Aetna Commercial |
$892.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$682.50
|
Rate for Payer: BCBS Complete |
$420.00
|
Rate for Payer: BCBS Trust/PPO |
$1,378.38
|
Rate for Payer: Cash Price |
$840.00
|
Rate for Payer: Cash Price |
$840.00
|
Rate for Payer: Cofinity Commercial |
$903.00
|
Rate for Payer: Cofinity Commercial |
$735.00
|
Rate for Payer: Healthscope Commercial |
$945.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
Rate for Payer: PHP Commercial |
$892.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
Rate for Payer: Priority Health SBD |
$661.50
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,050.00
|
|
Service Code
|
HCPCS L1499
|
Hospital Charge Code |
27400030
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$661.50 |
Max. Negotiated Rate |
$945.00 |
Rate for Payer: Aetna Commercial |
$892.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$682.50
|
Rate for Payer: Cash Price |
$840.00
|
Rate for Payer: Cofinity Commercial |
$735.00
|
Rate for Payer: Cofinity Commercial |
$903.00
|
Rate for Payer: Healthscope Commercial |
$945.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
Rate for Payer: PHP Commercial |
$892.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
Rate for Payer: Priority Health SBD |
$661.50
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,767.38
|
|
Hospital Charge Code |
27000032
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$3,633.45 |
Max. Negotiated Rate |
$5,190.64 |
Rate for Payer: Aetna Commercial |
$4,902.27
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.80
|
Rate for Payer: Cash Price |
$4,613.90
|
Rate for Payer: Cofinity Commercial |
$4,037.17
|
Rate for Payer: Cofinity Commercial |
$4,959.95
|
Rate for Payer: Healthscope Commercial |
$5,190.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
Rate for Payer: PHP Commercial |
$4,902.27
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
Rate for Payer: Priority Health SBD |
$3,633.45
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,767.38
|
|
Hospital Charge Code |
27000032
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$2,306.95 |
Max. Negotiated Rate |
$5,190.64 |
Rate for Payer: Aetna Commercial |
$4,902.27
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.80
|
Rate for Payer: BCBS Complete |
$2,306.95
|
Rate for Payer: Cash Price |
$4,613.90
|
Rate for Payer: Cofinity Commercial |
$4,037.17
|
Rate for Payer: Cofinity Commercial |
$4,959.95
|
Rate for Payer: Healthscope Commercial |
$5,190.64
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
Rate for Payer: PHP Commercial |
$4,902.27
|
Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
Rate for Payer: Priority Health SBD |
$3,633.45
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,453.00
|
|
Service Code
|
HCPCS L0200
|
Hospital Charge Code |
27400029
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$915.39 |
Max. Negotiated Rate |
$1,307.70 |
Rate for Payer: Aetna Commercial |
$1,235.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$944.45
|
Rate for Payer: Cash Price |
$1,162.40
|
Rate for Payer: Cofinity Commercial |
$1,017.10
|
Rate for Payer: Cofinity Commercial |
$1,249.58
|
Rate for Payer: Healthscope Commercial |
$1,307.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
Rate for Payer: PHP Commercial |
$1,235.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
Rate for Payer: Priority Health SBD |
$915.39
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,453.00
|
|
Service Code
|
HCPCS L0200
|
Hospital Charge Code |
27400029
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$581.20 |
Max. Negotiated Rate |
$2,056.63 |
Rate for Payer: Aetna Commercial |
$1,235.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$944.45
|
Rate for Payer: BCBS Complete |
$581.20
|
Rate for Payer: BCBS Trust/PPO |
$2,056.63
|
Rate for Payer: Cash Price |
$1,162.40
|
Rate for Payer: Cash Price |
$1,162.40
|
Rate for Payer: Cofinity Commercial |
$1,017.10
|
Rate for Payer: Cofinity Commercial |
$1,249.58
|
Rate for Payer: Healthscope Commercial |
$1,307.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
Rate for Payer: PHP Commercial |
$1,235.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
Rate for Payer: Priority Health SBD |
$915.39
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$909.04
|
Rate for Payer: UHC Exchange |
$757.53
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$270.00
|
|
Service Code
|
HCPCS L1499
|
Hospital Charge Code |
27400045
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$170.10 |
Max. Negotiated Rate |
$243.00 |
Rate for Payer: Aetna Commercial |
$229.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$175.50
|
Rate for Payer: Cash Price |
$216.00
|
Rate for Payer: Cofinity Commercial |
$189.00
|
Rate for Payer: Cofinity Commercial |
$232.20
|
Rate for Payer: Healthscope Commercial |
$243.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
Rate for Payer: PHP Commercial |
$229.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
Rate for Payer: Priority Health SBD |
$170.10
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$270.00
|
|
Service Code
|
HCPCS L1499
|
Hospital Charge Code |
27400045
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$108.00 |
Max. Negotiated Rate |
$1,378.38 |
Rate for Payer: Aetna Commercial |
$229.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$175.50
|
Rate for Payer: BCBS Complete |
$108.00
|
Rate for Payer: BCBS Trust/PPO |
$1,378.38
|
Rate for Payer: Cash Price |
$216.00
|
Rate for Payer: Cash Price |
$216.00
|
Rate for Payer: Cofinity Commercial |
$232.20
|
Rate for Payer: Cofinity Commercial |
$189.00
|
Rate for Payer: Healthscope Commercial |
$243.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
Rate for Payer: PHP Commercial |
$229.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
Rate for Payer: Priority Health SBD |
$170.10
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$69.00
|
|
Service Code
|
HCPCS L3908
|
Hospital Charge Code |
27400013
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$27.60 |
Max. Negotiated Rate |
$222.34 |
Rate for Payer: Aetna Commercial |
$58.65
|
Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
Rate for Payer: BCBS Complete |
$27.60
|
Rate for Payer: BCBS Trust/PPO |
$222.34
|
Rate for Payer: Cash Price |
$55.20
|
Rate for Payer: Cash Price |
$55.20
|
Rate for Payer: Cofinity Commercial |
$59.34
|
Rate for Payer: Cofinity Commercial |
$48.30
|
Rate for Payer: Healthscope Commercial |
$62.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
Rate for Payer: PHP Commercial |
$58.65
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
Rate for Payer: Priority Health SBD |
$43.47
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$103.20
|
Rate for Payer: UHC Exchange |
$86.00
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$69.00
|
|
Service Code
|
HCPCS L3908
|
Hospital Charge Code |
27400013
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$43.47 |
Max. Negotiated Rate |
$62.10 |
Rate for Payer: Aetna Commercial |
$58.65
|
Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
Rate for Payer: Cash Price |
$55.20
|
Rate for Payer: Cofinity Commercial |
$48.30
|
Rate for Payer: Cofinity Commercial |
$59.34
|
Rate for Payer: Healthscope Commercial |
$62.10
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
Rate for Payer: PHP Commercial |
$58.65
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
Rate for Payer: Priority Health SBD |
$43.47
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,055.83
|
|
Service Code
|
HCPCS L3760
|
Hospital Charge Code |
27000004
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$665.17 |
Max. Negotiated Rate |
$950.25 |
Rate for Payer: Aetna Commercial |
$897.46
|
Rate for Payer: Aetna New Business (MI Preferred) |
$686.29
|
Rate for Payer: Cash Price |
$844.66
|
Rate for Payer: Cofinity Commercial |
$739.08
|
Rate for Payer: Cofinity Commercial |
$908.01
|
Rate for Payer: Healthscope Commercial |
$950.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
Rate for Payer: PHP Commercial |
$897.46
|
Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
Rate for Payer: Priority Health SBD |
$665.17
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,055.83
|
|
Service Code
|
HCPCS L3760
|
Hospital Charge Code |
27000004
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$422.33 |
Max. Negotiated Rate |
$1,516.69 |
Rate for Payer: Aetna Commercial |
$897.46
|
Rate for Payer: Aetna New Business (MI Preferred) |
$686.29
|
Rate for Payer: BCBS Complete |
$422.33
|
Rate for Payer: BCBS Trust/PPO |
$1,516.69
|
Rate for Payer: Cash Price |
$844.66
|
Rate for Payer: Cash Price |
$844.66
|
Rate for Payer: Cofinity Commercial |
$739.08
|
Rate for Payer: Cofinity Commercial |
$908.01
|
Rate for Payer: Healthscope Commercial |
$950.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
Rate for Payer: PHP Commercial |
$897.46
|
Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
Rate for Payer: Priority Health SBD |
$665.17
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$765.42
|
Rate for Payer: UHC Exchange |
$637.85
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$685.00
|
|
Service Code
|
HCPCS L3763
|
Hospital Charge Code |
27400047
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$274.00 |
Max. Negotiated Rate |
$2,269.47 |
Rate for Payer: Aetna Commercial |
$582.25
|
Rate for Payer: Aetna New Business (MI Preferred) |
$445.25
|
Rate for Payer: BCBS Complete |
$274.00
|
Rate for Payer: BCBS Trust/PPO |
$2,269.47
|
Rate for Payer: Cash Price |
$548.00
|
Rate for Payer: Cash Price |
$548.00
|
Rate for Payer: Cofinity Commercial |
$479.50
|
Rate for Payer: Cofinity Commercial |
$589.10
|
Rate for Payer: Healthscope Commercial |
$616.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
Rate for Payer: PHP Commercial |
$582.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
Rate for Payer: Priority Health SBD |
$431.55
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.78
|
Rate for Payer: UHC Exchange |
$938.98
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$685.00
|
|
Service Code
|
HCPCS L3763
|
Hospital Charge Code |
27400047
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$431.55 |
Max. Negotiated Rate |
$616.50 |
Rate for Payer: Aetna Commercial |
$582.25
|
Rate for Payer: Aetna New Business (MI Preferred) |
$445.25
|
Rate for Payer: Cash Price |
$548.00
|
Rate for Payer: Cofinity Commercial |
$479.50
|
Rate for Payer: Cofinity Commercial |
$589.10
|
Rate for Payer: Healthscope Commercial |
$616.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
Rate for Payer: PHP Commercial |
$582.25
|
Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
Rate for Payer: Priority Health SBD |
$431.55
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.00
|
|
Service Code
|
HCPCS A9283
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$25.20 |
Max. Negotiated Rate |
$36.00 |
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.00
|
|
Service Code
|
HCPCS A9283
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$16.00 |
Max. Negotiated Rate |
$36.00 |
Rate for Payer: Aetna Commercial |
$34.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
Rate for Payer: BCBS Complete |
$16.00
|
Rate for Payer: Cash Price |
$32.00
|
Rate for Payer: Cofinity Commercial |
$28.00
|
Rate for Payer: Cofinity Commercial |
$34.40
|
Rate for Payer: Healthscope Commercial |
$36.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
Rate for Payer: PHP Commercial |
$34.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
Rate for Payer: Priority Health SBD |
$25.20
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$196.00
|
|
Service Code
|
HCPCS L3933
|
Hospital Charge Code |
27400043
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$78.40 |
Max. Negotiated Rate |
$647.07 |
Rate for Payer: Aetna Commercial |
$166.60
|
Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
Rate for Payer: BCBS Complete |
$78.40
|
Rate for Payer: BCBS Trust/PPO |
$647.07
|
Rate for Payer: Cash Price |
$156.80
|
Rate for Payer: Cash Price |
$156.80
|
Rate for Payer: Cofinity Commercial |
$168.56
|
Rate for Payer: Cofinity Commercial |
$137.20
|
Rate for Payer: Healthscope Commercial |
$176.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
Rate for Payer: PHP Commercial |
$166.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
Rate for Payer: Priority Health SBD |
$123.48
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$326.54
|
Rate for Payer: UHC Exchange |
$272.12
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$196.00
|
|
Service Code
|
HCPCS L3933
|
Hospital Charge Code |
27400043
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$123.48 |
Max. Negotiated Rate |
$176.40 |
Rate for Payer: Aetna Commercial |
$166.60
|
Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
Rate for Payer: Cash Price |
$156.80
|
Rate for Payer: Cofinity Commercial |
$137.20
|
Rate for Payer: Cofinity Commercial |
$168.56
|
Rate for Payer: Healthscope Commercial |
$176.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
Rate for Payer: PHP Commercial |
$166.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
Rate for Payer: Priority Health SBD |
$123.48
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$414.37
|
|
Service Code
|
HCPCS L4386
|
Hospital Charge Code |
27400002
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$261.05 |
Max. Negotiated Rate |
$372.93 |
Rate for Payer: Aetna Commercial |
$352.21
|
Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
Rate for Payer: Cash Price |
$331.50
|
Rate for Payer: Cofinity Commercial |
$290.06
|
Rate for Payer: Cofinity Commercial |
$356.36
|
Rate for Payer: Healthscope Commercial |
$372.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
Rate for Payer: PHP Commercial |
$352.21
|
Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
Rate for Payer: Priority Health SBD |
$261.05
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$414.37
|
|
Service Code
|
HCPCS L4386
|
Hospital Charge Code |
27400002
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$165.75 |
Max. Negotiated Rate |
$528.34 |
Rate for Payer: Aetna Commercial |
$352.21
|
Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
Rate for Payer: BCBS Complete |
$165.75
|
Rate for Payer: BCBS Trust/PPO |
$528.34
|
Rate for Payer: Cash Price |
$331.50
|
Rate for Payer: Cash Price |
$331.50
|
Rate for Payer: Cofinity Commercial |
$356.36
|
Rate for Payer: Cofinity Commercial |
$290.06
|
Rate for Payer: Healthscope Commercial |
$372.93
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
Rate for Payer: PHP Commercial |
$352.21
|
Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
Rate for Payer: Priority Health SBD |
$261.05
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$266.63
|
Rate for Payer: UHC Exchange |
$222.19
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$497.24
|
|
Service Code
|
HCPCS L4387
|
Hospital Charge Code |
27400022
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$198.90 |
Max. Negotiated Rate |
$528.34 |
Rate for Payer: Aetna Commercial |
$422.65
|
Rate for Payer: Aetna New Business (MI Preferred) |
$323.21
|
Rate for Payer: BCBS Complete |
$198.90
|
Rate for Payer: BCBS Trust/PPO |
$528.34
|
Rate for Payer: Cash Price |
$397.79
|
Rate for Payer: Cash Price |
$397.79
|
Rate for Payer: Cofinity Commercial |
$348.07
|
Rate for Payer: Cofinity Commercial |
$427.63
|
Rate for Payer: Healthscope Commercial |
$447.52
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
Rate for Payer: PHP Commercial |
$422.65
|
Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
Rate for Payer: Priority Health SBD |
$313.26
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$266.63
|
Rate for Payer: UHC Exchange |
$222.19
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$497.24
|
|
Service Code
|
HCPCS L4387
|
Hospital Charge Code |
27400022
|
Hospital Revenue Code
|
274
|
Min. Negotiated Rate |
$313.26 |
Max. Negotiated Rate |
$447.52 |
Rate for Payer: Aetna Commercial |
$422.65
|
Rate for Payer: Aetna New Business (MI Preferred) |
$323.21
|
Rate for Payer: Cash Price |
$397.79
|
Rate for Payer: Cofinity Commercial |
$348.07
|
Rate for Payer: Cofinity Commercial |
$427.63
|
Rate for Payer: Healthscope Commercial |
$447.52
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
Rate for Payer: PHP Commercial |
$422.65
|
Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
Rate for Payer: Priority Health SBD |
$313.26
|
|