|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$364.52
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$364.52 |
| Rate for Payer: Aetna Commercial |
$328.07
|
| Rate for Payer: ASR ASR |
$353.58
|
| Rate for Payer: BCBS Trust/PPO |
$282.61
|
| Rate for Payer: BCN Commercial |
$282.61
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$364.52
|
| Rate for Payer: Healthscope Whirlpool |
$353.58
|
| Rate for Payer: Mclaren Commercial |
$328.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.78
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.72 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Aetna Commercial |
$350.37
|
| Rate for Payer: ASR ASR |
$377.62
|
| Rate for Payer: BCBS Complete |
$155.72
|
| Rate for Payer: BCBS Trust/PPO |
$301.82
|
| Rate for Payer: BCN Commercial |
$301.82
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$365.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Healthscope Commercial |
$389.30
|
| Rate for Payer: Healthscope Whirlpool |
$377.62
|
| Rate for Payer: Mclaren Commercial |
$350.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.26
|
| Rate for Payer: Priority Health Narrow Network |
$276.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.58
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.51 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Aetna Commercial |
$350.37
|
| Rate for Payer: ASR ASR |
$377.62
|
| Rate for Payer: BCBS Trust/PPO |
$301.82
|
| Rate for Payer: BCN Commercial |
$301.82
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$365.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Healthscope Commercial |
$389.30
|
| Rate for Payer: Healthscope Whirlpool |
$377.62
|
| Rate for Payer: Mclaren Commercial |
$350.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.58
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.29 |
| Max. Negotiated Rate |
$428.23 |
| Rate for Payer: Aetna Commercial |
$385.41
|
| Rate for Payer: ASR ASR |
$415.38
|
| Rate for Payer: BCBS Complete |
$171.29
|
| Rate for Payer: BCBS Trust/PPO |
$332.01
|
| Rate for Payer: BCN Commercial |
$332.01
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$402.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Healthscope Commercial |
$428.23
|
| Rate for Payer: Healthscope Whirlpool |
$415.38
|
| Rate for Payer: Mclaren Commercial |
$385.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.69
|
| Rate for Payer: Priority Health Narrow Network |
$304.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.84
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.76 |
| Max. Negotiated Rate |
$428.23 |
| Rate for Payer: Aetna Commercial |
$385.41
|
| Rate for Payer: ASR ASR |
$415.38
|
| Rate for Payer: BCBS Trust/PPO |
$332.01
|
| Rate for Payer: BCN Commercial |
$332.01
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$402.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Healthscope Commercial |
$428.23
|
| Rate for Payer: Healthscope Whirlpool |
$415.38
|
| Rate for Payer: Mclaren Commercial |
$385.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.84
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.16 |
| Max. Negotiated Rate |
$527.89 |
| Rate for Payer: Aetna Commercial |
$475.10
|
| Rate for Payer: ASR ASR |
$512.05
|
| Rate for Payer: BCBS Complete |
$211.16
|
| Rate for Payer: BCBS Trust/PPO |
$409.27
|
| Rate for Payer: BCN Commercial |
$409.27
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Healthscope Commercial |
$527.89
|
| Rate for Payer: Healthscope Whirlpool |
$512.05
|
| Rate for Payer: Mclaren Commercial |
$475.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.38
|
| Rate for Payer: Priority Health Narrow Network |
$374.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.54
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$369.52 |
| Max. Negotiated Rate |
$527.89 |
| Rate for Payer: Aetna Commercial |
$475.10
|
| Rate for Payer: ASR ASR |
$512.05
|
| Rate for Payer: BCBS Trust/PPO |
$409.27
|
| Rate for Payer: BCN Commercial |
$409.27
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Healthscope Commercial |
$527.89
|
| Rate for Payer: Healthscope Whirlpool |
$512.05
|
| Rate for Payer: Mclaren Commercial |
$475.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.54
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$181.43 |
| Rate for Payer: Aetna Commercial |
$163.29
|
| Rate for Payer: ASR ASR |
$175.99
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS Trust/PPO |
$140.66
|
| Rate for Payer: BCN Commercial |
$140.66
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$170.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$181.43
|
| Rate for Payer: Healthscope Whirlpool |
$175.99
|
| Rate for Payer: Mclaren Commercial |
$163.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.10
|
| Rate for Payer: Priority Health Narrow Network |
$128.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.66
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$181.43 |
| Rate for Payer: Aetna Commercial |
$163.29
|
| Rate for Payer: ASR ASR |
$175.99
|
| Rate for Payer: BCBS Trust/PPO |
$140.66
|
| Rate for Payer: BCN Commercial |
$140.66
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$170.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$181.43
|
| Rate for Payer: Healthscope Whirlpool |
$175.99
|
| Rate for Payer: Mclaren Commercial |
$163.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.66
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$369.14 |
| Max. Negotiated Rate |
$527.34 |
| Rate for Payer: Aetna Commercial |
$474.61
|
| Rate for Payer: ASR ASR |
$511.52
|
| Rate for Payer: BCBS Trust/PPO |
$408.85
|
| Rate for Payer: BCN Commercial |
$408.85
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cofinity Commercial |
$495.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.87
|
| Rate for Payer: Healthscope Commercial |
$527.34
|
| Rate for Payer: Healthscope Whirlpool |
$511.52
|
| Rate for Payer: Mclaren Commercial |
$474.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.06
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$527.34 |
| Rate for Payer: Aetna Commercial |
$474.61
|
| Rate for Payer: ASR ASR |
$511.52
|
| Rate for Payer: BCBS Complete |
$210.94
|
| Rate for Payer: BCBS Trust/PPO |
$408.85
|
| Rate for Payer: BCN Commercial |
$408.85
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cofinity Commercial |
$495.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.87
|
| Rate for Payer: Healthscope Commercial |
$527.34
|
| Rate for Payer: Healthscope Whirlpool |
$511.52
|
| Rate for Payer: Mclaren Commercial |
$474.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.88
|
| Rate for Payer: Priority Health Narrow Network |
$374.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.06
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna Commercial |
$52.24
|
| Rate for Payer: ASR ASR |
$56.30
|
| Rate for Payer: BCBS Trust/PPO |
$45.00
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$58.04
|
| Rate for Payer: Healthscope Whirlpool |
$56.30
|
| Rate for Payer: Mclaren Commercial |
$52.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.08
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna Commercial |
$52.24
|
| Rate for Payer: ASR ASR |
$56.30
|
| Rate for Payer: BCBS Complete |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$45.00
|
| Rate for Payer: BCN Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$58.04
|
| Rate for Payer: Healthscope Whirlpool |
$56.30
|
| Rate for Payer: Mclaren Commercial |
$52.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.82
|
| Rate for Payer: Priority Health Narrow Network |
$41.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.08
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.79 |
| Max. Negotiated Rate |
$309.47 |
| Rate for Payer: Aetna Commercial |
$278.52
|
| Rate for Payer: ASR ASR |
$300.19
|
| Rate for Payer: BCBS Complete |
$123.79
|
| Rate for Payer: BCBS Trust/PPO |
$239.93
|
| Rate for Payer: BCN Commercial |
$239.93
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$290.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$309.47
|
| Rate for Payer: Healthscope Whirlpool |
$300.19
|
| Rate for Payer: Mclaren Commercial |
$278.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.62
|
| Rate for Payer: Priority Health Narrow Network |
$219.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.33
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.63 |
| Max. Negotiated Rate |
$309.47 |
| Rate for Payer: Aetna Commercial |
$278.52
|
| Rate for Payer: ASR ASR |
$300.19
|
| Rate for Payer: BCBS Trust/PPO |
$239.93
|
| Rate for Payer: BCN Commercial |
$239.93
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$290.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$309.47
|
| Rate for Payer: Healthscope Whirlpool |
$300.19
|
| Rate for Payer: Mclaren Commercial |
$278.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.33
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Aetna Commercial |
$138.62
|
| Rate for Payer: ASR ASR |
$149.40
|
| Rate for Payer: BCBS Complete |
$61.61
|
| Rate for Payer: BCBS Trust/PPO |
$119.41
|
| Rate for Payer: BCN Commercial |
$119.41
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Healthscope Whirlpool |
$149.40
|
| Rate for Payer: Mclaren Commercial |
$138.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.16
|
| Rate for Payer: Priority Health Narrow Network |
$109.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.54
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.81 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Aetna Commercial |
$138.62
|
| Rate for Payer: ASR ASR |
$149.40
|
| Rate for Payer: BCBS Trust/PPO |
$119.41
|
| Rate for Payer: BCN Commercial |
$119.41
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Healthscope Whirlpool |
$149.40
|
| Rate for Payer: Mclaren Commercial |
$138.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.54
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.85 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Aetna Commercial |
$97.52
|
| Rate for Payer: ASR ASR |
$105.11
|
| Rate for Payer: BCBS Trust/PPO |
$84.01
|
| Rate for Payer: BCN Commercial |
$84.01
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$108.36
|
| Rate for Payer: Healthscope Whirlpool |
$105.11
|
| Rate for Payer: Mclaren Commercial |
$97.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.36
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Aetna Commercial |
$97.52
|
| Rate for Payer: ASR ASR |
$105.11
|
| Rate for Payer: BCBS Complete |
$43.34
|
| Rate for Payer: BCBS Trust/PPO |
$84.01
|
| Rate for Payer: BCN Commercial |
$84.01
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$101.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$108.36
|
| Rate for Payer: Healthscope Whirlpool |
$105.11
|
| Rate for Payer: Mclaren Commercial |
$97.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.61
|
| Rate for Payer: Priority Health Narrow Network |
$76.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.36
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$96.49 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: ASR ASR |
$93.60
|
| Rate for Payer: BCBS Complete |
$38.60
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$74.81
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$90.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$96.49
|
| Rate for Payer: Healthscope Whirlpool |
$93.60
|
| Rate for Payer: Mclaren Commercial |
$86.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.81
|
| Rate for Payer: Priority Health Narrow Network |
$68.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.91
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$96.49 |
| Rate for Payer: Aetna Commercial |
$86.84
|
| Rate for Payer: ASR ASR |
$93.60
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$74.81
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$90.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$96.49
|
| Rate for Payer: Healthscope Whirlpool |
$93.60
|
| Rate for Payer: Mclaren Commercial |
$86.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.91
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,880.00
|
| Rate for Payer: ASR ASR |
$3,104.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,480.96
|
| Rate for Payer: BCN Commercial |
$2,480.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,008.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,104.00
|
| Rate for Payer: Mclaren Commercial |
$2,880.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,816.00
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,280.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,880.00
|
| Rate for Payer: ASR ASR |
$3,104.00
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,480.96
|
| Rate for Payer: BCN Commercial |
$2,480.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,008.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,104.00
|
| Rate for Payer: Mclaren Commercial |
$2,880.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,912.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,272.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,816.00
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.01 |
| Max. Negotiated Rate |
$2,957.53 |
| Rate for Payer: Aetna Commercial |
$2,661.78
|
| Rate for Payer: ASR ASR |
$2,868.80
|
| Rate for Payer: BCBS Complete |
$1,183.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,292.97
|
| Rate for Payer: BCN Commercial |
$2,292.97
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,780.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Healthscope Commercial |
$2,957.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,868.80
|
| Rate for Payer: Mclaren Commercial |
$2,661.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,691.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,099.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,602.63
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,070.27 |
| Max. Negotiated Rate |
$2,957.53 |
| Rate for Payer: Aetna Commercial |
$2,661.78
|
| Rate for Payer: ASR ASR |
$2,868.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,292.97
|
| Rate for Payer: BCN Commercial |
$2,292.97
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,780.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Healthscope Commercial |
$2,957.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,868.80
|
| Rate for Payer: Mclaren Commercial |
$2,661.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,602.63
|
|
