|
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
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,090.05 |
| Max. Negotiated Rate |
$4,338.86 |
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: Aetna Medicare |
$1,386.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,802.89
|
| Rate for Payer: BCBS Complete |
$1,109.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,338.86
|
| Rate for Payer: BCN Commercial |
$4,338.86
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Advantage |
$1,941.57
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,218.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,592.13
|
| Rate for Payer: Priority Health SBD |
$1,747.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,273.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.89
|
| Rate for Payer: UHC Core |
$1,445.08
|
| Rate for Payer: UHC Exchange |
$1,090.05
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,747.41 |
| Max. Negotiated Rate |
$2,496.30 |
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,802.89
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Advantage |
$1,941.57
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: Priority Health SBD |
$1,747.41
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.05 |
| Max. Negotiated Rate |
$526.23 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna Medicare |
$189.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.51
|
| Rate for Payer: BCBS Complete |
$151.70
|
| Rate for Payer: BCBS Trust/PPO |
$526.23
|
| Rate for Payer: BCN Commercial |
$526.23
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Advantage |
$265.48
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193.10
|
| Rate for Payer: Priority Health SBD |
$238.93
|
| Rate for Payer: Priority Health Tiered Network |
$154.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.51
|
| Rate for Payer: UHC Core |
$197.59
|
| Rate for Payer: UHC Exchange |
$149.05
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.51
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Advantage |
$265.48
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: Priority Health SBD |
$238.93
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.17 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.27
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Advantage |
$283.52
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: Priority Health SBD |
$255.17
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.18 |
| Max. Negotiated Rate |
$562.03 |
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna Medicare |
$202.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.27
|
| Rate for Payer: BCBS Complete |
$162.01
|
| Rate for Payer: BCBS Trust/PPO |
$562.03
|
| Rate for Payer: BCN Commercial |
$562.03
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Advantage |
$283.52
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.23
|
| Rate for Payer: Priority Health SBD |
$255.17
|
| Rate for Payer: Priority Health Tiered Network |
$164.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.27
|
| Rate for Payer: UHC Core |
$211.02
|
| Rate for Payer: UHC Exchange |
$159.18
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.98 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: Aetna Medicare |
$222.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: BCBS Complete |
$178.21
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Advantage |
$311.87
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.23
|
| Rate for Payer: Priority Health SBD |
$280.68
|
| Rate for Payer: Priority Health Tiered Network |
$164.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.59
|
| Rate for Payer: UHC Core |
$232.12
|
| Rate for Payer: UHC Exchange |
$175.09
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$280.68 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Advantage |
$311.87
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: Priority Health SBD |
$280.68
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.01 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health SBD |
$346.01
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.84 |
| Max. Negotiated Rate |
$762.17 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna Medicare |
$274.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: BCBS Complete |
$219.69
|
| Rate for Payer: BCBS Trust/PPO |
$762.17
|
| Rate for Payer: BCN Commercial |
$762.17
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$279.67
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: Priority Health Tiered Network |
$223.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.99
|
| Rate for Payer: UHC Core |
$286.14
|
| Rate for Payer: UHC Exchange |
$215.84
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$200.47 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Medicare |
$94.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: BCBS Complete |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$200.47
|
| Rate for Payer: BCN Commercial |
$200.47
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Advantage |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.56
|
| Rate for Payer: Priority Health SBD |
$118.92
|
| Rate for Payer: Priority Health Tiered Network |
$58.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.69
|
| Rate for Payer: UHC Core |
$98.34
|
| Rate for Payer: UHC Exchange |
$74.18
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.92 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Advantage |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health SBD |
$118.92
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$2,197.85 |
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: Aetna Medicare |
$274.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.62
|
| Rate for Payer: BCBS Complete |
$219.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,197.85
|
| Rate for Payer: BCN Commercial |
$2,197.85
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Advantage |
$384.06
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$806.49
|
| Rate for Payer: Priority Health SBD |
$345.65
|
| Rate for Payer: Priority Health Tiered Network |
$645.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.62
|
| Rate for Payer: UHC Core |
$285.85
|
| Rate for Payer: UHC Exchange |
$215.62
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$345.65 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.62
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Advantage |
$384.06
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: Priority Health SBD |
$345.65
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.22
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Advantage |
$43.31
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: Priority Health SBD |
$38.98
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$88.59 |
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.22
|
| Rate for Payer: BCBS Complete |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$88.59
|
| Rate for Payer: BCN Commercial |
$88.59
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Advantage |
$43.31
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32.51
|
| Rate for Payer: Priority Health SBD |
$38.98
|
| Rate for Payer: Priority Health Tiered Network |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Core |
$32.23
|
| Rate for Payer: UHC Exchange |
$24.31
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna Medicare |
$160.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.28
|
| Rate for Payer: BCBS Complete |
$128.79
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Advantage |
$225.38
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.57
|
| Rate for Payer: Priority Health SBD |
$202.84
|
| Rate for Payer: Priority Health Tiered Network |
$174.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.28
|
| Rate for Payer: UHC Core |
$167.75
|
| Rate for Payer: UHC Exchange |
$126.53
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.28
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Advantage |
$225.38
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: Priority Health SBD |
$202.84
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$222.35 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$80.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: BCBS Complete |
$64.10
|
| Rate for Payer: BCBS Trust/PPO |
$222.35
|
| Rate for Payer: BCN Commercial |
$222.35
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.59
|
| Rate for Payer: Priority Health SBD |
$100.95
|
| Rate for Payer: Priority Health Tiered Network |
$65.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.16
|
| Rate for Payer: UHC Core |
$83.49
|
| Rate for Payer: UHC Exchange |
$62.97
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health SBD |
$100.95
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.28
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Advantage |
$78.92
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: Priority Health SBD |
$71.03
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.31 |
| Max. Negotiated Rate |
$156.41 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna Medicare |
$56.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.28
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$156.41
|
| Rate for Payer: BCN Commercial |
$156.41
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Advantage |
$78.92
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.40
|
| Rate for Payer: Priority Health SBD |
$71.03
|
| Rate for Payer: Priority Health Tiered Network |
$45.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.28
|
| Rate for Payer: UHC Core |
$58.74
|
| Rate for Payer: UHC Exchange |
$44.31
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$85.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.25
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Advantage |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$86.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$90.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: PHP Commercial |
$85.33
|
| Rate for Payer: Priority Health SBD |
$63.25
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$223.46 |
| Rate for Payer: Aetna Commercial |
$85.33
|
| Rate for Payer: Aetna Medicare |
$50.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.25
|
| Rate for Payer: BCBS Complete |
$40.16
|
| Rate for Payer: BCBS Trust/PPO |
$223.46
|
| Rate for Payer: BCN Commercial |
$223.46
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Advantage |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$86.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$90.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: PHP Commercial |
$85.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$63.25
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.25
|
| Rate for Payer: UHC Core |
$52.30
|
| Rate for Payer: UHC Exchange |
$39.45
|
|
