|
HC BRACE TLSO
|
Facility
|
OP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,308.41 |
| Max. Negotiated Rate |
$6,853.29 |
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: Aetna Medicare |
$1,664.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,164.03
|
| Rate for Payer: BCBS Complete |
$1,331.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,853.29
|
| Rate for Payer: BCN Commercial |
$6,853.29
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Advantage |
$2,330.50
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,663.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,514.79
|
| Rate for Payer: Priority Health SBD |
$2,097.45
|
| Rate for Payer: Priority Health Tiered Network |
$2,011.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,164.03
|
| Rate for Payer: UHC Core |
$1,734.55
|
| Rate for Payer: UHC Exchange |
$1,308.41
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,097.45 |
| Max. Negotiated Rate |
$2,996.35 |
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,164.03
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Advantage |
$2,330.50
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: Priority Health SBD |
$2,097.45
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,938.52 |
| Max. Negotiated Rate |
$2,769.31 |
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.06
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Advantage |
$2,153.91
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: Priority Health SBD |
$1,938.52
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,209.26 |
| Max. Negotiated Rate |
$4,978.36 |
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: Aetna Medicare |
$1,538.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.06
|
| Rate for Payer: BCBS Complete |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,978.36
|
| Rate for Payer: BCN Commercial |
$4,978.36
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Advantage |
$2,153.91
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,461.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,826.79
|
| Rate for Payer: Priority Health SBD |
$1,938.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,461.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,000.06
|
| Rate for Payer: UHC Core |
$1,603.12
|
| Rate for Payer: UHC Exchange |
$1,209.26
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,287.47 |
| Max. Negotiated Rate |
$1,839.25 |
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.35
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Advantage |
$1,430.53
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: Priority Health SBD |
$1,287.47
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$803.14 |
| Max. Negotiated Rate |
$3,362.02 |
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: Aetna Medicare |
$1,021.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.35
|
| Rate for Payer: BCBS Complete |
$817.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,362.02
|
| Rate for Payer: BCN Commercial |
$3,362.02
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Advantage |
$1,430.53
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,634.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,233.68
|
| Rate for Payer: Priority Health SBD |
$1,287.47
|
| Rate for Payer: Priority Health Tiered Network |
$986.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,328.35
|
| Rate for Payer: UHC Core |
$1,064.72
|
| Rate for Payer: UHC Exchange |
$803.14
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Advantage |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health SBD |
$30.81
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$1,197.33 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: BCBS Complete |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.33
|
| Rate for Payer: BCN Commercial |
$1,197.33
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Advantage |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.35
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Priority Health Tiered Network |
$351.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.79
|
| Rate for Payer: UHC Core |
$25.48
|
| Rate for Payer: UHC Exchange |
$19.22
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Advantage |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health SBD |
$23.23
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$223.46 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$18.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$223.46
|
| Rate for Payer: BCN Commercial |
$223.46
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Advantage |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$23.23
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.97
|
| Rate for Payer: UHC Core |
$19.21
|
| Rate for Payer: UHC Exchange |
$14.49
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$205.14 |
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: Aetna Medicare |
$75.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.81
|
| Rate for Payer: BCBS Complete |
$60.19
|
| Rate for Payer: BCBS Trust/PPO |
$205.14
|
| Rate for Payer: BCN Commercial |
$205.14
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Advantage |
$105.33
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75.28
|
| Rate for Payer: Priority Health SBD |
$94.80
|
| Rate for Payer: Priority Health Tiered Network |
$60.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.81
|
| Rate for Payer: UHC Core |
$78.39
|
| Rate for Payer: UHC Exchange |
$59.13
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.81
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Advantage |
$105.33
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: Priority Health SBD |
$94.80
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$311.36 |
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.87
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Advantage |
$242.16
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: Priority Health SBD |
$217.95
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.96 |
| Max. Negotiated Rate |
$1,085.81 |
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: Aetna Medicare |
$172.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.87
|
| Rate for Payer: BCBS Complete |
$138.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.81
|
| Rate for Payer: BCN Commercial |
$1,085.81
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Advantage |
$242.16
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$398.43
|
| Rate for Payer: Priority Health SBD |
$217.95
|
| Rate for Payer: Priority Health Tiered Network |
$318.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.87
|
| Rate for Payer: UHC Core |
$180.24
|
| Rate for Payer: UHC Exchange |
$135.96
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.52 |
| Max. Negotiated Rate |
$1,544.62 |
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: Aetna Medicare |
$246.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.07
|
| Rate for Payer: BCBS Complete |
$196.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.62
|
| Rate for Payer: BCN Commercial |
$1,544.62
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Advantage |
$344.69
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$566.79
|
| Rate for Payer: Priority Health SBD |
$310.22
|
| Rate for Payer: Priority Health Tiered Network |
$453.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.07
|
| Rate for Payer: UHC Core |
$256.55
|
| Rate for Payer: UHC Exchange |
$193.52
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.22 |
| Max. Negotiated Rate |
$443.17 |
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.07
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Advantage |
$344.69
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: Priority Health SBD |
$310.22
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,361.71
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,487.88 |
| Max. Negotiated Rate |
$2,125.54 |
| Rate for Payer: Aetna Commercial |
$2,007.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.11
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cofinity Advantage |
$1,653.20
|
| Rate for Payer: Cofinity Commercial |
$2,031.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.37
|
| Rate for Payer: Healthscope Commercial |
$2,125.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,771.28
|
| Rate for Payer: PHP Commercial |
$2,007.45
|
| Rate for Payer: Priority Health SBD |
$1,487.88
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,361.71
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$887.33 |
| Max. Negotiated Rate |
$3,022.67 |
| Rate for Payer: Aetna Commercial |
$2,007.45
|
| Rate for Payer: Aetna Medicare |
$1,180.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.11
|
| Rate for Payer: BCBS Complete |
$944.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,022.67
|
| Rate for Payer: BCN Commercial |
$3,022.67
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cofinity Advantage |
$1,653.20
|
| Rate for Payer: Cofinity Commercial |
$2,031.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.37
|
| Rate for Payer: Healthscope Commercial |
$2,125.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,889.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,771.28
|
| Rate for Payer: PHP Commercial |
$2,007.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,109.16
|
| Rate for Payer: Priority Health SBD |
$1,487.88
|
| Rate for Payer: Priority Health Tiered Network |
$887.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,535.11
|
| Rate for Payer: UHC Core |
$1,230.45
|
| Rate for Payer: UHC Exchange |
$928.15
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$156.10
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.34 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.47
|
| Rate for Payer: Cash Price |
$124.88
|
| Rate for Payer: Cofinity Advantage |
$109.27
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.88
|
| Rate for Payer: Healthscope Commercial |
$140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.08
|
| Rate for Payer: PHP Commercial |
$132.69
|
| Rate for Payer: Priority Health SBD |
$98.34
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$156.10
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$223.46 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.47
|
| Rate for Payer: BCBS Complete |
$62.44
|
| Rate for Payer: BCBS Trust/PPO |
$223.46
|
| Rate for Payer: BCN Commercial |
$223.46
|
| Rate for Payer: Cash Price |
$124.88
|
| Rate for Payer: Cash Price |
$124.88
|
| Rate for Payer: Cofinity Advantage |
$109.27
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.88
|
| Rate for Payer: Healthscope Commercial |
$140.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.08
|
| Rate for Payer: PHP Commercial |
$132.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$98.34
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.47
|
| Rate for Payer: UHC Core |
$81.33
|
| Rate for Payer: UHC Exchange |
$61.35
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$228.69
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$205.82 |
| Rate for Payer: Aetna Commercial |
$194.39
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.66
|
| Rate for Payer: BCBS Complete |
$19.62
|
| Rate for Payer: BCBS MAPPO |
$35.73
|
| Rate for Payer: BCN Medicare Advantage |
$35.73
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cofinity Advantage |
$160.08
|
| Rate for Payer: Cofinity Commercial |
$196.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.73
|
| Rate for Payer: Healthscope Commercial |
$205.82
|
| Rate for Payer: Mclaren Medicaid |
$18.69
|
| Rate for Payer: Mclaren Medicare |
$35.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.52
|
| Rate for Payer: Meridian Medicaid |
$37.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.39
|
| Rate for Payer: Nomi Health Commercial |
$107.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.52
|
| Rate for Payer: PACE Medicare |
$33.94
|
| Rate for Payer: PACE SWMI |
$35.73
|
| Rate for Payer: PHP Commercial |
$194.39
|
| Rate for Payer: PHP Medicare Advantage |
$35.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.56
|
| Rate for Payer: Priority Health Medicare |
$35.73
|
| Rate for Payer: Priority Health SBD |
$144.07
|
| Rate for Payer: Priority Health Tiered Network |
$92.45
|
| Rate for Payer: Railroad Medicare Medicare |
$35.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.65
|
| Rate for Payer: UHC Core |
$119.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.73
|
| Rate for Payer: UHC Exchange |
$89.88
|
| Rate for Payer: UHC Medicaid |
$18.69
|
| Rate for Payer: UHCCP Medicaid |
$18.69
|
| Rate for Payer: VA VA |
$35.73
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$228.69
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.07 |
| Max. Negotiated Rate |
$205.82 |
| Rate for Payer: Aetna Commercial |
$194.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.65
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cofinity Advantage |
$160.08
|
| Rate for Payer: Cofinity Commercial |
$196.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.95
|
| Rate for Payer: Healthscope Commercial |
$205.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.52
|
| Rate for Payer: PHP Commercial |
$194.39
|
| Rate for Payer: Priority Health SBD |
$144.07
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,822.59
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,148.23 |
| Max. Negotiated Rate |
$1,640.33 |
| Rate for Payer: Aetna Commercial |
$1,549.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.68
|
| Rate for Payer: Cash Price |
$1,458.07
|
| Rate for Payer: Cofinity Advantage |
$1,275.81
|
| Rate for Payer: Cofinity Commercial |
$1,567.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,458.07
|
| Rate for Payer: Healthscope Commercial |
$1,640.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,549.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.94
|
| Rate for Payer: PHP Commercial |
$1,549.20
|
| Rate for Payer: Priority Health SBD |
$1,148.23
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,822.59
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$729.04 |
| Max. Negotiated Rate |
$1,640.33 |
| Rate for Payer: Aetna Commercial |
$1,549.20
|
| Rate for Payer: Aetna Medicare |
$911.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.68
|
| Rate for Payer: BCBS Complete |
$729.04
|
| Rate for Payer: Cash Price |
$1,458.07
|
| Rate for Payer: Cofinity Advantage |
$1,275.81
|
| Rate for Payer: Cofinity Commercial |
$1,567.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,458.07
|
| Rate for Payer: Healthscope Commercial |
$1,640.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,458.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,549.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.94
|
| Rate for Payer: PHP Commercial |
$1,549.20
|
| Rate for Payer: Priority Health SBD |
$1,148.23
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
