|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: BCN Commercial |
$278.41
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$102.16
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: Priority Health Tiered Network |
$81.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$236.86 |
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$236.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: PHP Commercial |
$223.70
|
| Rate for Payer: Priority Health SBD |
$165.80
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.43 |
| Max. Negotiated Rate |
$825.46 |
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: Aetna Medicare |
$131.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: BCBS Complete |
$105.27
|
| Rate for Payer: BCBS Trust/PPO |
$825.46
|
| Rate for Payer: BCN Commercial |
$825.46
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$236.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: PHP Commercial |
$223.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.90
|
| Rate for Payer: Priority Health SBD |
$165.80
|
| Rate for Payer: Priority Health Tiered Network |
$242.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$137.12
|
| Rate for Payer: UHC Exchange |
$103.43
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$740.66 |
| Max. Negotiated Rate |
$3,138.23 |
| Rate for Payer: Aetna Commercial |
$1,601.93
|
| Rate for Payer: Aetna Medicare |
$942.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.00
|
| Rate for Payer: BCBS Complete |
$753.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,138.23
|
| Rate for Payer: BCN Commercial |
$3,138.23
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Advantage |
$1,319.23
|
| Rate for Payer: Cofinity Commercial |
$1,620.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,696.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,507.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: PHP Commercial |
$1,601.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,151.56
|
| Rate for Payer: Priority Health SBD |
$1,187.31
|
| Rate for Payer: Priority Health Tiered Network |
$921.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,225.00
|
| Rate for Payer: UHC Core |
$981.89
|
| Rate for Payer: UHC Exchange |
$740.66
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,187.31 |
| Max. Negotiated Rate |
$1,696.16 |
| Rate for Payer: Aetna Commercial |
$1,601.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Advantage |
$1,319.23
|
| Rate for Payer: Cofinity Commercial |
$1,620.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,696.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: PHP Commercial |
$1,601.93
|
| Rate for Payer: Priority Health SBD |
$1,187.31
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$1,179.18 |
| Rate for Payer: Aetna Commercial |
$722.27
|
| Rate for Payer: Aetna Medicare |
$424.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.32
|
| Rate for Payer: BCBS Complete |
$339.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.18
|
| Rate for Payer: BCN Commercial |
$1,179.18
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Advantage |
$594.81
|
| Rate for Payer: Cofinity Commercial |
$730.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$764.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$679.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: PHP Commercial |
$722.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$432.69
|
| Rate for Payer: Priority Health SBD |
$535.33
|
| Rate for Payer: Priority Health Tiered Network |
$346.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.32
|
| Rate for Payer: UHC Core |
$442.71
|
| Rate for Payer: UHC Exchange |
$333.94
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$535.33 |
| Max. Negotiated Rate |
$764.76 |
| Rate for Payer: Aetna Commercial |
$722.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.32
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Advantage |
$594.81
|
| Rate for Payer: Cofinity Commercial |
$730.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$764.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: PHP Commercial |
$722.27
|
| Rate for Payer: Priority Health SBD |
$535.33
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$615.59 |
| Max. Negotiated Rate |
$879.41 |
| Rate for Payer: Aetna Commercial |
$830.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.13
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Advantage |
$683.98
|
| Rate for Payer: Cofinity Commercial |
$840.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$879.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: PHP Commercial |
$830.55
|
| Rate for Payer: Priority Health SBD |
$615.59
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.01 |
| Max. Negotiated Rate |
$1,355.94 |
| Rate for Payer: Aetna Commercial |
$830.55
|
| Rate for Payer: Aetna Medicare |
$488.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.13
|
| Rate for Payer: BCBS Complete |
$390.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.94
|
| Rate for Payer: BCN Commercial |
$1,355.94
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Advantage |
$683.98
|
| Rate for Payer: Cofinity Commercial |
$840.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$879.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: PHP Commercial |
$830.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$497.56
|
| Rate for Payer: Priority Health SBD |
$615.59
|
| Rate for Payer: Priority Health Tiered Network |
$398.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.13
|
| Rate for Payer: UHC Core |
$509.08
|
| Rate for Payer: UHC Exchange |
$384.01
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,194.38 |
| Max. Negotiated Rate |
$4,563.40 |
| Rate for Payer: Aetna Commercial |
$4,309.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,295.79
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Advantage |
$3,549.31
|
| Rate for Payer: Cofinity Commercial |
$4,360.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,563.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: PHP Commercial |
$4,309.87
|
| Rate for Payer: Priority Health SBD |
$3,194.38
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.68 |
| Max. Negotiated Rate |
$4,563.40 |
| Rate for Payer: Aetna Commercial |
$4,309.87
|
| Rate for Payer: Aetna Medicare |
$2,535.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,295.79
|
| Rate for Payer: BCBS Complete |
$2,028.18
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Advantage |
$3,549.31
|
| Rate for Payer: Cofinity Commercial |
$4,360.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,563.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,056.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: PHP Commercial |
$4,309.87
|
| Rate for Payer: Priority Health SBD |
$3,194.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,295.79
|
| Rate for Payer: UHC Core |
$2,641.70
|
| Rate for Payer: UHC Exchange |
$1,992.68
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.34 |
| Max. Negotiated Rate |
$2,306.90 |
| Rate for Payer: Aetna Commercial |
$1,201.12
|
| Rate for Payer: Aetna Medicare |
$706.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.50
|
| Rate for Payer: BCBS Complete |
$565.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,306.90
|
| Rate for Payer: BCN Commercial |
$2,306.90
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Advantage |
$989.16
|
| Rate for Payer: Cofinity Commercial |
$1,215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,271.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,130.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: PHP Commercial |
$1,201.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$846.51
|
| Rate for Payer: Priority Health SBD |
$890.24
|
| Rate for Payer: Priority Health Tiered Network |
$677.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.50
|
| Rate for Payer: UHC Core |
$736.21
|
| Rate for Payer: UHC Exchange |
$555.34
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$890.24 |
| Max. Negotiated Rate |
$1,271.77 |
| Rate for Payer: Aetna Commercial |
$1,201.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.50
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Advantage |
$989.16
|
| Rate for Payer: Cofinity Commercial |
$1,215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,271.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: PHP Commercial |
$1,201.12
|
| Rate for Payer: Priority Health SBD |
$890.24
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,662.46
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.35 |
| Max. Negotiated Rate |
$1,496.21 |
| Rate for Payer: Aetna Commercial |
$1,413.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cofinity Advantage |
$1,163.72
|
| Rate for Payer: Cofinity Commercial |
$1,429.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,329.97
|
| Rate for Payer: Healthscope Commercial |
$1,496.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,246.85
|
| Rate for Payer: PHP Commercial |
$1,413.09
|
| Rate for Payer: Priority Health SBD |
$1,047.35
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,662.46
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$407.70 |
| Max. Negotiated Rate |
$1,496.21 |
| Rate for Payer: Aetna Commercial |
$1,413.09
|
| Rate for Payer: Aetna Medicare |
$831.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.60
|
| Rate for Payer: BCBS Complete |
$664.98
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cofinity Advantage |
$1,163.72
|
| Rate for Payer: Cofinity Commercial |
$1,429.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,329.97
|
| Rate for Payer: Healthscope Commercial |
$1,496.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,329.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,246.85
|
| Rate for Payer: PHP Commercial |
$1,413.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$509.63
|
| Rate for Payer: Priority Health SBD |
$1,047.35
|
| Rate for Payer: Priority Health Tiered Network |
$407.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,080.60
|
| Rate for Payer: UHC Core |
$866.14
|
| Rate for Payer: UHC Exchange |
$653.35
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$206.89
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$191.49 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Medicare |
$103.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.48
|
| Rate for Payer: BCBS Complete |
$82.76
|
| Rate for Payer: BCBS Trust/PPO |
$191.49
|
| Rate for Payer: BCN Commercial |
$191.49
|
| Rate for Payer: Cash Price |
$165.51
|
| Rate for Payer: Cash Price |
$165.51
|
| Rate for Payer: Cofinity Advantage |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$177.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.51
|
| Rate for Payer: Healthscope Commercial |
$186.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.17
|
| Rate for Payer: PHP Commercial |
$175.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.75
|
| Rate for Payer: Priority Health SBD |
$130.34
|
| Rate for Payer: Priority Health Tiered Network |
$56.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.48
|
| Rate for Payer: UHC Core |
$107.79
|
| Rate for Payer: UHC Exchange |
$81.31
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$206.89
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.48
|
| Rate for Payer: Cash Price |
$165.51
|
| Rate for Payer: Cofinity Advantage |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$177.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.51
|
| Rate for Payer: Healthscope Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.17
|
| Rate for Payer: PHP Commercial |
$175.86
|
| Rate for Payer: Priority Health SBD |
$130.34
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$664.82
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.27 |
| Max. Negotiated Rate |
$1,376.59 |
| Rate for Payer: Aetna Commercial |
$565.10
|
| Rate for Payer: Aetna Medicare |
$332.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.13
|
| Rate for Payer: BCBS Complete |
$265.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,376.59
|
| Rate for Payer: BCN Commercial |
$1,376.59
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cofinity Advantage |
$465.37
|
| Rate for Payer: Cofinity Commercial |
$571.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.86
|
| Rate for Payer: Healthscope Commercial |
$598.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.62
|
| Rate for Payer: PHP Commercial |
$565.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$505.13
|
| Rate for Payer: Priority Health SBD |
$418.84
|
| Rate for Payer: Priority Health Tiered Network |
$404.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.13
|
| Rate for Payer: UHC Core |
$346.37
|
| Rate for Payer: UHC Exchange |
$261.27
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$664.82
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.84 |
| Max. Negotiated Rate |
$598.34 |
| Rate for Payer: Aetna Commercial |
$565.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.13
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cofinity Advantage |
$465.37
|
| Rate for Payer: Cofinity Commercial |
$571.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.86
|
| Rate for Payer: Healthscope Commercial |
$598.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.62
|
| Rate for Payer: PHP Commercial |
$565.10
|
| Rate for Payer: Priority Health SBD |
$418.84
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$189.35
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.29 |
| Max. Negotiated Rate |
$170.41 |
| Rate for Payer: Aetna Commercial |
$160.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.08
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cofinity Advantage |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$162.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.48
|
| Rate for Payer: Healthscope Commercial |
$170.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.01
|
| Rate for Payer: PHP Commercial |
$160.95
|
| Rate for Payer: Priority Health SBD |
$119.29
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$189.35
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$261.04 |
| Rate for Payer: Aetna Commercial |
$160.95
|
| Rate for Payer: Aetna Medicare |
$94.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.08
|
| Rate for Payer: BCBS Complete |
$75.74
|
| Rate for Payer: BCBS Trust/PPO |
$261.04
|
| Rate for Payer: BCN Commercial |
$261.04
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cofinity Advantage |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$162.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.48
|
| Rate for Payer: Healthscope Commercial |
$170.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.01
|
| Rate for Payer: PHP Commercial |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.79
|
| Rate for Payer: Priority Health SBD |
$119.29
|
| Rate for Payer: Priority Health Tiered Network |
$76.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.08
|
| Rate for Payer: UHC Core |
$98.65
|
| Rate for Payer: UHC Exchange |
$74.41
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$198.82
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna Commercial |
$169.00
|
| Rate for Payer: Aetna Medicare |
$99.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: BCBS Complete |
$79.53
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cofinity Advantage |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.06
|
| Rate for Payer: Healthscope Commercial |
$178.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.12
|
| Rate for Payer: PHP Commercial |
$169.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.40
|
| Rate for Payer: Priority Health SBD |
$125.26
|
| Rate for Payer: Priority Health Tiered Network |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: UHC Exchange |
$78.14
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$198.82
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna Commercial |
$169.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cofinity Advantage |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.06
|
| Rate for Payer: Healthscope Commercial |
$178.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.12
|
| Rate for Payer: PHP Commercial |
$169.00
|
| Rate for Payer: Priority Health SBD |
$125.26
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,605.60
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,641.53 |
| Max. Negotiated Rate |
$2,345.04 |
| Rate for Payer: Aetna Commercial |
$2,214.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,693.64
|
| Rate for Payer: Cash Price |
$2,084.48
|
| Rate for Payer: Cofinity Advantage |
$1,823.92
|
| Rate for Payer: Cofinity Commercial |
$2,240.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,084.48
|
| Rate for Payer: Healthscope Commercial |
$2,345.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,214.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.20
|
| Rate for Payer: PHP Commercial |
$2,214.76
|
| Rate for Payer: Priority Health SBD |
$1,641.53
|
|
