|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: ASR ASR |
$66.93
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$53.50
|
| Rate for Payer: BCN Commercial |
$53.50
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$64.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Healthscope Whirlpool |
$66.93
|
| Rate for Payer: Mclaren Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.79
|
| Rate for Payer: Priority Health Narrow Network |
$48.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.72
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.08 |
| Max. Negotiated Rate |
$1,055.83 |
| Rate for Payer: Aetna Commercial |
$950.25
|
| Rate for Payer: ASR ASR |
$1,024.16
|
| Rate for Payer: BCBS Trust/PPO |
$818.58
|
| Rate for Payer: BCN Commercial |
$818.58
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$992.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Healthscope Commercial |
$1,055.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.16
|
| Rate for Payer: Mclaren Commercial |
$950.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.13
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$1,055.83 |
| Rate for Payer: Aetna Commercial |
$950.25
|
| Rate for Payer: ASR ASR |
$1,024.16
|
| Rate for Payer: BCBS Complete |
$422.33
|
| Rate for Payer: BCBS Trust/PPO |
$818.58
|
| Rate for Payer: BCN Commercial |
$818.58
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$992.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Healthscope Commercial |
$1,055.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.16
|
| Rate for Payer: Mclaren Commercial |
$950.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.81
|
| Rate for Payer: Priority Health Narrow Network |
$749.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.13
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$616.50
|
| Rate for Payer: ASR ASR |
$664.45
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS Trust/PPO |
$531.08
|
| Rate for Payer: BCN Commercial |
$531.08
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$643.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Healthscope Commercial |
$685.00
|
| Rate for Payer: Healthscope Whirlpool |
$664.45
|
| Rate for Payer: Mclaren Commercial |
$616.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$623.35
|
| Rate for Payer: Priority Health Narrow Network |
$486.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.80
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$616.50
|
| Rate for Payer: ASR ASR |
$664.45
|
| Rate for Payer: BCBS Trust/PPO |
$531.08
|
| Rate for Payer: BCN Commercial |
$531.08
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$643.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Healthscope Commercial |
$685.00
|
| Rate for Payer: Healthscope Whirlpool |
$664.45
|
| Rate for Payer: Mclaren Commercial |
$616.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.80
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: ASR ASR |
$38.80
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$31.01
|
| Rate for Payer: BCN Commercial |
$31.01
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$40.00
|
| Rate for Payer: Healthscope Whirlpool |
$38.80
|
| Rate for Payer: Mclaren Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.40
|
| Rate for Payer: Priority Health Narrow Network |
$28.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.20
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: ASR ASR |
$38.80
|
| Rate for Payer: BCBS Trust/PPO |
$31.01
|
| Rate for Payer: BCN Commercial |
$31.01
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$40.00
|
| Rate for Payer: Healthscope Whirlpool |
$38.80
|
| Rate for Payer: Mclaren Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.20
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Trust/PPO |
$151.96
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.36
|
| Rate for Payer: Priority Health Narrow Network |
$139.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: BCBS Trust/PPO |
$151.96
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$414.37
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$414.37 |
| Rate for Payer: Aetna Commercial |
$372.93
|
| Rate for Payer: ASR ASR |
$401.94
|
| Rate for Payer: BCBS Complete |
$165.75
|
| Rate for Payer: BCBS Trust/PPO |
$321.26
|
| Rate for Payer: BCN Commercial |
$321.26
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$389.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$414.37
|
| Rate for Payer: Healthscope Whirlpool |
$401.94
|
| Rate for Payer: Mclaren Commercial |
$372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.08
|
| Rate for Payer: Priority Health Narrow Network |
$294.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.65
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$414.37
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.06 |
| Max. Negotiated Rate |
$414.37 |
| Rate for Payer: Aetna Commercial |
$372.93
|
| Rate for Payer: ASR ASR |
$401.94
|
| Rate for Payer: BCBS Trust/PPO |
$321.26
|
| Rate for Payer: BCN Commercial |
$321.26
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$389.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$414.37
|
| Rate for Payer: Healthscope Whirlpool |
$401.94
|
| Rate for Payer: Mclaren Commercial |
$372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$364.65
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.07 |
| Max. Negotiated Rate |
$497.24 |
| Rate for Payer: Aetna Commercial |
$447.52
|
| Rate for Payer: ASR ASR |
$482.32
|
| Rate for Payer: BCBS Trust/PPO |
$385.51
|
| Rate for Payer: BCN Commercial |
$385.51
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$467.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Healthscope Commercial |
$497.24
|
| Rate for Payer: Healthscope Whirlpool |
$482.32
|
| Rate for Payer: Mclaren Commercial |
$447.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.57
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$497.24 |
| Rate for Payer: Aetna Commercial |
$447.52
|
| Rate for Payer: ASR ASR |
$482.32
|
| Rate for Payer: BCBS Complete |
$198.90
|
| Rate for Payer: BCBS Trust/PPO |
$385.51
|
| Rate for Payer: BCN Commercial |
$385.51
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$467.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Healthscope Commercial |
$497.24
|
| Rate for Payer: Healthscope Whirlpool |
$482.32
|
| Rate for Payer: Mclaren Commercial |
$447.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.49
|
| Rate for Payer: Priority Health Narrow Network |
$353.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.57
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$264.60
|
| Rate for Payer: ASR ASR |
$285.18
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.94
|
| Rate for Payer: BCN Commercial |
$227.94
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Healthscope Commercial |
$294.00
|
| Rate for Payer: Healthscope Whirlpool |
$285.18
|
| Rate for Payer: Mclaren Commercial |
$264.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.54
|
| Rate for Payer: Priority Health Narrow Network |
$208.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.72
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$264.60
|
| Rate for Payer: ASR ASR |
$285.18
|
| Rate for Payer: BCBS Trust/PPO |
$227.94
|
| Rate for Payer: BCN Commercial |
$227.94
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Healthscope Commercial |
$294.00
|
| Rate for Payer: Healthscope Whirlpool |
$285.18
|
| Rate for Payer: Mclaren Commercial |
$264.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.72
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$201.55 |
| Max. Negotiated Rate |
$503.88 |
| Rate for Payer: Aetna Commercial |
$453.49
|
| Rate for Payer: ASR ASR |
$488.76
|
| Rate for Payer: BCBS Complete |
$201.55
|
| Rate for Payer: BCBS Trust/PPO |
$390.66
|
| Rate for Payer: BCN Commercial |
$390.66
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$473.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Healthscope Commercial |
$503.88
|
| Rate for Payer: Healthscope Whirlpool |
$488.76
|
| Rate for Payer: Mclaren Commercial |
$453.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.53
|
| Rate for Payer: Priority Health Narrow Network |
$357.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.41
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.72 |
| Max. Negotiated Rate |
$503.88 |
| Rate for Payer: Aetna Commercial |
$453.49
|
| Rate for Payer: ASR ASR |
$488.76
|
| Rate for Payer: BCBS Trust/PPO |
$390.66
|
| Rate for Payer: BCN Commercial |
$390.66
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$473.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Healthscope Commercial |
$503.88
|
| Rate for Payer: Healthscope Whirlpool |
$488.76
|
| Rate for Payer: Mclaren Commercial |
$453.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.41
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.78 |
| Max. Negotiated Rate |
$412.54 |
| Rate for Payer: Aetna Commercial |
$371.29
|
| Rate for Payer: ASR ASR |
$400.16
|
| Rate for Payer: BCBS Trust/PPO |
$319.84
|
| Rate for Payer: BCN Commercial |
$319.84
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$387.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Healthscope Commercial |
$412.54
|
| Rate for Payer: Healthscope Whirlpool |
$400.16
|
| Rate for Payer: Mclaren Commercial |
$371.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.04
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.02 |
| Max. Negotiated Rate |
$412.54 |
| Rate for Payer: Aetna Commercial |
$371.29
|
| Rate for Payer: ASR ASR |
$400.16
|
| Rate for Payer: BCBS Complete |
$165.02
|
| Rate for Payer: BCBS Trust/PPO |
$319.84
|
| Rate for Payer: BCN Commercial |
$319.84
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$387.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Healthscope Commercial |
$412.54
|
| Rate for Payer: Healthscope Whirlpool |
$400.16
|
| Rate for Payer: Mclaren Commercial |
$371.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.41
|
| Rate for Payer: Priority Health Narrow Network |
$292.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.04
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: ASR ASR |
$174.60
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.55
|
| Rate for Payer: BCN Commercial |
$139.55
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Healthscope Whirlpool |
$174.60
|
| Rate for Payer: Mclaren Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.80
|
| Rate for Payer: Priority Health Narrow Network |
$127.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.40
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.75
|
| Rate for Payer: Priority Health Narrow Network |
$88.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$252.96 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: ASR ASR |
$245.37
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: BCN Commercial |
$196.12
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$237.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$252.96
|
| Rate for Payer: Healthscope Whirlpool |
$245.37
|
| Rate for Payer: Mclaren Commercial |
$227.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.19
|
| Rate for Payer: Priority Health Narrow Network |
$179.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.60
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.07 |
| Max. Negotiated Rate |
$252.96 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: ASR ASR |
$245.37
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: BCN Commercial |
$196.12
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$237.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$252.96
|
| Rate for Payer: Healthscope Whirlpool |
$245.37
|
| Rate for Payer: Mclaren Commercial |
$227.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.60
|
|
