|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.95 |
| Max. Negotiated Rate |
$2,076.05 |
| Rate for Payer: Aetna Commercial |
$1,271.65
|
| Rate for Payer: Aetna Medicare |
$748.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.44
|
| Rate for Payer: BCBS Complete |
$598.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.05
|
| Rate for Payer: BCN Commercial |
$2,076.05
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Advantage |
$1,047.24
|
| Rate for Payer: Cofinity Commercial |
$1,286.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Healthscope Commercial |
$1,346.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: PHP Commercial |
$1,271.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$761.80
|
| Rate for Payer: Priority Health SBD |
$942.52
|
| Rate for Payer: Priority Health Tiered Network |
$609.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$972.44
|
| Rate for Payer: UHC Core |
$779.45
|
| Rate for Payer: UHC Exchange |
$587.95
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$942.52 |
| Max. Negotiated Rate |
$1,346.45 |
| Rate for Payer: Aetna Commercial |
$1,271.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.44
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Advantage |
$1,047.24
|
| Rate for Payer: Cofinity Commercial |
$1,286.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Healthscope Commercial |
$1,346.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: PHP Commercial |
$1,271.65
|
| Rate for Payer: Priority Health SBD |
$942.52
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.94 |
| Max. Negotiated Rate |
$302.77 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.67
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Advantage |
$235.49
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Healthscope Commercial |
$302.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: PHP Commercial |
$285.95
|
| Rate for Payer: Priority Health SBD |
$211.94
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$443.31 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna Medicare |
$168.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.67
|
| Rate for Payer: BCBS Complete |
$134.56
|
| Rate for Payer: BCBS Trust/PPO |
$443.31
|
| Rate for Payer: BCN Commercial |
$443.31
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Advantage |
$235.49
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Healthscope Commercial |
$302.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: PHP Commercial |
$285.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$162.67
|
| Rate for Payer: Priority Health SBD |
$211.94
|
| Rate for Payer: Priority Health Tiered Network |
$130.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.67
|
| Rate for Payer: UHC Core |
$175.27
|
| Rate for Payer: UHC Exchange |
$132.21
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$121.64 |
| Rate for Payer: Aetna Commercial |
$114.88
|
| Rate for Payer: Aetna Medicare |
$67.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.85
|
| Rate for Payer: BCBS Complete |
$54.06
|
| Rate for Payer: BCBS Trust/PPO |
$30.72
|
| Rate for Payer: BCN Commercial |
$30.72
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Advantage |
$94.61
|
| Rate for Payer: Cofinity Commercial |
$116.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: PHP Commercial |
$114.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.27
|
| Rate for Payer: Priority Health SBD |
$85.14
|
| Rate for Payer: Priority Health Tiered Network |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.85
|
| Rate for Payer: UHC Core |
$70.41
|
| Rate for Payer: UHC Exchange |
$53.11
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.14 |
| Max. Negotiated Rate |
$121.64 |
| Rate for Payer: Aetna Commercial |
$114.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.85
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Advantage |
$94.61
|
| Rate for Payer: Cofinity Commercial |
$116.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: PHP Commercial |
$114.88
|
| Rate for Payer: Priority Health SBD |
$85.14
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$962.06 |
| Max. Negotiated Rate |
$1,374.37 |
| Rate for Payer: Aetna Commercial |
$1,298.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$992.60
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Advantage |
$1,068.96
|
| Rate for Payer: Cofinity Commercial |
$1,313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Healthscope Commercial |
$1,374.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: PHP Commercial |
$1,298.02
|
| Rate for Payer: Priority Health SBD |
$962.06
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.14 |
| Max. Negotiated Rate |
$2,081.55 |
| Rate for Payer: Aetna Commercial |
$1,298.02
|
| Rate for Payer: Aetna Medicare |
$763.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$992.60
|
| Rate for Payer: BCBS Complete |
$610.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.55
|
| Rate for Payer: BCN Commercial |
$2,081.55
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Advantage |
$1,068.96
|
| Rate for Payer: Cofinity Commercial |
$1,313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Healthscope Commercial |
$1,374.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,221.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: PHP Commercial |
$1,298.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.82
|
| Rate for Payer: Priority Health SBD |
$962.06
|
| Rate for Payer: Priority Health Tiered Network |
$611.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.60
|
| Rate for Payer: UHC Core |
$795.61
|
| Rate for Payer: UHC Exchange |
$600.14
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$324.03 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: Aetna Medicare |
$75.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$324.03
|
| Rate for Payer: BCN Commercial |
$324.03
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Advantage |
$105.27
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$118.90
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: Priority Health Tiered Network |
$95.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.75
|
| Rate for Payer: UHC Core |
$78.35
|
| Rate for Payer: UHC Exchange |
$59.10
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Advantage |
$105.27
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health SBD |
$94.75
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.02 |
| Max. Negotiated Rate |
$474.33 |
| Rate for Payer: Aetna Commercial |
$296.34
|
| Rate for Payer: Aetna Medicare |
$174.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.62
|
| Rate for Payer: BCBS Complete |
$139.46
|
| Rate for Payer: BCBS Trust/PPO |
$474.33
|
| Rate for Payer: BCN Commercial |
$474.33
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Advantage |
$244.05
|
| Rate for Payer: Cofinity Commercial |
$299.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Healthscope Commercial |
$313.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: PHP Commercial |
$296.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$174.05
|
| Rate for Payer: Priority Health SBD |
$219.64
|
| Rate for Payer: Priority Health Tiered Network |
$139.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.62
|
| Rate for Payer: UHC Core |
$181.64
|
| Rate for Payer: UHC Exchange |
$137.02
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$313.78 |
| Rate for Payer: Aetna Commercial |
$296.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.62
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Advantage |
$244.05
|
| Rate for Payer: Cofinity Commercial |
$299.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Healthscope Commercial |
$313.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: PHP Commercial |
$296.34
|
| Rate for Payer: Priority Health SBD |
$219.64
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$277.25 |
| Rate for Payer: Aetna Commercial |
$261.85
|
| Rate for Payer: Aetna Medicare |
$154.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.24
|
| Rate for Payer: BCBS Complete |
$123.22
|
| Rate for Payer: BCBS Trust/PPO |
$69.99
|
| Rate for Payer: BCN Commercial |
$69.99
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Advantage |
$215.64
|
| Rate for Payer: Cofinity Commercial |
$264.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Healthscope Commercial |
$277.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: PHP Commercial |
$261.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.68
|
| Rate for Payer: Priority Health SBD |
$194.08
|
| Rate for Payer: Priority Health Tiered Network |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.24
|
| Rate for Payer: UHC Core |
$160.50
|
| Rate for Payer: UHC Exchange |
$121.07
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$277.25 |
| Rate for Payer: Aetna Commercial |
$261.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.24
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Advantage |
$215.64
|
| Rate for Payer: Cofinity Commercial |
$264.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Healthscope Commercial |
$277.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: PHP Commercial |
$261.85
|
| Rate for Payer: Priority Health SBD |
$194.08
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$88.17 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.68
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Advantage |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Healthscope Commercial |
$88.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: PHP Commercial |
$83.27
|
| Rate for Payer: Priority Health SBD |
$61.72
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$88.17 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$48.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.68
|
| Rate for Payer: BCBS Complete |
$39.19
|
| Rate for Payer: BCBS Trust/PPO |
$22.27
|
| Rate for Payer: BCN Commercial |
$22.27
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Advantage |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Healthscope Commercial |
$88.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: PHP Commercial |
$83.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.17
|
| Rate for Payer: Priority Health SBD |
$61.72
|
| Rate for Payer: Priority Health Tiered Network |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.68
|
| Rate for Payer: UHC Core |
$51.04
|
| Rate for Payer: UHC Exchange |
$38.50
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.53 |
| Max. Negotiated Rate |
$1,029.33 |
| Rate for Payer: Aetna Commercial |
$972.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.40
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Advantage |
$800.59
|
| Rate for Payer: Cofinity Commercial |
$983.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,029.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: PHP Commercial |
$972.14
|
| Rate for Payer: Priority Health SBD |
$720.53
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.47 |
| Max. Negotiated Rate |
$1,587.01 |
| Rate for Payer: Aetna Commercial |
$972.14
|
| Rate for Payer: Aetna Medicare |
$571.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.40
|
| Rate for Payer: BCBS Complete |
$457.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.01
|
| Rate for Payer: BCN Commercial |
$1,587.01
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Advantage |
$800.59
|
| Rate for Payer: Cofinity Commercial |
$983.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,029.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$914.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: PHP Commercial |
$972.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$582.35
|
| Rate for Payer: Priority Health SBD |
$720.53
|
| Rate for Payer: Priority Health Tiered Network |
$465.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.40
|
| Rate for Payer: UHC Core |
$595.87
|
| Rate for Payer: UHC Exchange |
$449.47
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$809.05 |
| Max. Negotiated Rate |
$1,155.78 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.73
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Advantage |
$898.94
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: Priority Health SBD |
$809.05
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$504.69 |
| Max. Negotiated Rate |
$1,782.07 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna Medicare |
$642.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.73
|
| Rate for Payer: BCBS Complete |
$513.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,782.07
|
| Rate for Payer: BCN Commercial |
$1,782.07
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Advantage |
$898.94
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$653.92
|
| Rate for Payer: Priority Health SBD |
$809.05
|
| Rate for Payer: Priority Health Tiered Network |
$523.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.73
|
| Rate for Payer: UHC Core |
$669.07
|
| Rate for Payer: UHC Exchange |
$504.69
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$1,318.61 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.61
|
| Rate for Payer: BCN Commercial |
$1,318.61
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.07
|
| Rate for Payer: UHC Core |
$569.15
|
| Rate for Payer: UHC Exchange |
$429.32
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,780.24 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,900.25
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Advantage |
$4,200.27
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: Priority Health SBD |
$3,780.24
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,358.15 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: Aetna Medicare |
$3,000.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,900.25
|
| Rate for Payer: BCBS Complete |
$2,400.15
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Advantage |
$4,200.27
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,800.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: Priority Health SBD |
$3,780.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,900.25
|
| Rate for Payer: UHC Core |
$3,126.20
|
| Rate for Payer: UHC Exchange |
$2,358.15
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$952.37 |
| Max. Negotiated Rate |
$1,360.53 |
| Rate for Payer: Aetna Commercial |
$1,284.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.61
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Advantage |
$1,058.19
|
| Rate for Payer: Cofinity Commercial |
$1,300.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,360.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: PHP Commercial |
$1,284.94
|
| Rate for Payer: Priority Health SBD |
$952.37
|
|
