|
HC BOWL
|
Facility
|
OP
|
$234.09
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: Aetna Medicare |
$86.61
|
| Rate for Payer: ASR ASR |
$227.07
|
| Rate for Payer: BCBS Complete |
$93.64
|
| Rate for Payer: BCBS Trust/PPO |
$193.01
|
| Rate for Payer: BCN Commercial |
$193.01
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$227.07
|
| Rate for Payer: Healthscope Whirlpool |
$234.09
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.11
|
| Rate for Payer: Priority Health Narrow Network |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
OP
|
$258.54
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$258.54 |
| Rate for Payer: Aetna Commercial |
$232.69
|
| Rate for Payer: Aetna Medicare |
$95.66
|
| Rate for Payer: ASR ASR |
$250.78
|
| Rate for Payer: BCBS Complete |
$103.42
|
| Rate for Payer: BCBS Trust/PPO |
$213.17
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: Cash Price |
$206.83
|
| Rate for Payer: Cofinity Commercial |
$243.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.83
|
| Rate for Payer: Healthscope Commercial |
$250.78
|
| Rate for Payer: Healthscope Whirlpool |
$258.54
|
| Rate for Payer: Mclaren Commercial |
$232.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.76
|
| Rate for Payer: Nomi Health Commercial |
$212.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.53
|
| Rate for Payer: Priority Health Narrow Network |
$181.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.52
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
IP
|
$258.54
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$193.91 |
| Max. Negotiated Rate |
$258.54 |
| Rate for Payer: Aetna Commercial |
$232.69
|
| Rate for Payer: ASR ASR |
$250.78
|
| Rate for Payer: BCBS Trust/PPO |
$212.31
|
| Rate for Payer: BCN Commercial |
$212.31
|
| Rate for Payer: Cash Price |
$206.83
|
| Rate for Payer: Cofinity Commercial |
$243.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.83
|
| Rate for Payer: Healthscope Commercial |
$250.78
|
| Rate for Payer: Healthscope Whirlpool |
$258.54
|
| Rate for Payer: Mclaren Commercial |
$232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.76
|
| Rate for Payer: Nomi Health Commercial |
$212.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.52
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
IP
|
$53.49
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$53.49 |
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: ASR ASR |
$51.89
|
| Rate for Payer: BCBS Trust/PPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$43.93
|
| Rate for Payer: Cash Price |
$42.79
|
| Rate for Payer: Cofinity Commercial |
$50.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.79
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Mclaren Commercial |
$48.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.47
|
| Rate for Payer: Nomi Health Commercial |
$43.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.07
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$53.49
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$51.89
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$44.10
|
| Rate for Payer: BCN Commercial |
$44.10
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.79
|
| Rate for Payer: Cash Price |
$42.79
|
| Rate for Payer: Cofinity Commercial |
$50.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Healthscope Whirlpool |
$53.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$48.14
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.47
|
| Rate for Payer: Nomi Health Commercial |
$43.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.87
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$37.50
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCN Commercial |
$51.80
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.04
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$56.54
|
| Rate for Payer: ASR ASR |
$60.94
|
| Rate for Payer: BCBS Trust/PPO |
$51.59
|
| Rate for Payer: BCN Commercial |
$51.59
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$59.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$60.94
|
| Rate for Payer: Healthscope Whirlpool |
$62.82
|
| Rate for Payer: Mclaren Commercial |
$56.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.28
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$991.54
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$991.54 |
| Rate for Payer: Aetna Commercial |
$892.39
|
| Rate for Payer: ASR ASR |
$961.79
|
| Rate for Payer: BCBS Trust/PPO |
$814.25
|
| Rate for Payer: BCN Commercial |
$814.25
|
| Rate for Payer: Cash Price |
$793.23
|
| Rate for Payer: Cofinity Commercial |
$932.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.23
|
| Rate for Payer: Healthscope Commercial |
$961.79
|
| Rate for Payer: Healthscope Whirlpool |
$991.54
|
| Rate for Payer: Mclaren Commercial |
$892.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.81
|
| Rate for Payer: Nomi Health Commercial |
$813.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.56
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$991.54
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$366.87 |
| Max. Negotiated Rate |
$991.54 |
| Rate for Payer: Aetna Commercial |
$892.39
|
| Rate for Payer: Aetna Medicare |
$366.87
|
| Rate for Payer: ASR ASR |
$961.79
|
| Rate for Payer: BCBS Complete |
$396.62
|
| Rate for Payer: BCBS Trust/PPO |
$817.52
|
| Rate for Payer: BCN Commercial |
$817.52
|
| Rate for Payer: Cash Price |
$793.23
|
| Rate for Payer: Cofinity Commercial |
$932.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.23
|
| Rate for Payer: Healthscope Commercial |
$961.79
|
| Rate for Payer: Healthscope Whirlpool |
$991.54
|
| Rate for Payer: Mclaren Commercial |
$892.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$793.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.81
|
| Rate for Payer: Nomi Health Commercial |
$813.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$868.79
|
| Rate for Payer: Priority Health Narrow Network |
$695.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.56
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$608.06
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$456.05 |
| Max. Negotiated Rate |
$608.06 |
| Rate for Payer: Aetna Commercial |
$547.25
|
| Rate for Payer: ASR ASR |
$589.82
|
| Rate for Payer: BCBS Trust/PPO |
$499.34
|
| Rate for Payer: BCN Commercial |
$499.34
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.45
|
| Rate for Payer: Healthscope Commercial |
$589.82
|
| Rate for Payer: Healthscope Whirlpool |
$608.06
|
| Rate for Payer: Mclaren Commercial |
$547.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.85
|
| Rate for Payer: Nomi Health Commercial |
$498.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$535.09
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$608.06
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.98 |
| Max. Negotiated Rate |
$608.06 |
| Rate for Payer: Aetna Commercial |
$547.25
|
| Rate for Payer: Aetna Medicare |
$224.98
|
| Rate for Payer: ASR ASR |
$589.82
|
| Rate for Payer: BCBS Complete |
$243.22
|
| Rate for Payer: BCBS Trust/PPO |
$501.35
|
| Rate for Payer: BCN Commercial |
$501.35
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.45
|
| Rate for Payer: Healthscope Commercial |
$589.82
|
| Rate for Payer: Healthscope Whirlpool |
$608.06
|
| Rate for Payer: Mclaren Commercial |
$547.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.85
|
| Rate for Payer: Nomi Health Commercial |
$498.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$532.78
|
| Rate for Payer: Priority Health Narrow Network |
$426.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$535.09
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,122.05 |
| Max. Negotiated Rate |
$1,496.06 |
| Rate for Payer: Aetna Commercial |
$1,346.45
|
| Rate for Payer: ASR ASR |
$1,451.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.56
|
| Rate for Payer: BCN Commercial |
$1,228.56
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Commercial |
$1,406.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Healthscope Commercial |
$1,451.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.06
|
| Rate for Payer: Mclaren Commercial |
$1,346.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Nomi Health Commercial |
$1,226.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,316.53
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$1,496.06 |
| Rate for Payer: Aetna Commercial |
$1,346.45
|
| Rate for Payer: Aetna Medicare |
$553.54
|
| Rate for Payer: ASR ASR |
$1,451.18
|
| Rate for Payer: BCBS Complete |
$598.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.50
|
| Rate for Payer: BCN Commercial |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Commercial |
$1,406.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Healthscope Commercial |
$1,451.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.06
|
| Rate for Payer: Mclaren Commercial |
$1,346.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Nomi Health Commercial |
$1,226.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,310.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,048.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,316.53
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.31 |
| Max. Negotiated Rate |
$336.41 |
| Rate for Payer: Aetna Commercial |
$302.77
|
| Rate for Payer: ASR ASR |
$326.32
|
| Rate for Payer: BCBS Trust/PPO |
$276.26
|
| Rate for Payer: BCN Commercial |
$276.26
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Commercial |
$316.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Healthscope Commercial |
$326.32
|
| Rate for Payer: Healthscope Whirlpool |
$336.41
|
| Rate for Payer: Mclaren Commercial |
$302.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Nomi Health Commercial |
$275.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.04
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$336.41 |
| Rate for Payer: Aetna Commercial |
$302.77
|
| Rate for Payer: Aetna Medicare |
$124.47
|
| Rate for Payer: ASR ASR |
$326.32
|
| Rate for Payer: BCBS Complete |
$134.56
|
| Rate for Payer: BCBS Trust/PPO |
$277.37
|
| Rate for Payer: BCN Commercial |
$277.37
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Commercial |
$316.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Healthscope Commercial |
$326.32
|
| Rate for Payer: Healthscope Whirlpool |
$336.41
|
| Rate for Payer: Mclaren Commercial |
$302.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Nomi Health Commercial |
$275.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.76
|
| Rate for Payer: Priority Health Narrow Network |
$235.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.04
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: Aetna Commercial |
$121.64
|
| Rate for Payer: ASR ASR |
$131.10
|
| Rate for Payer: BCBS Trust/PPO |
$110.99
|
| Rate for Payer: BCN Commercial |
$110.99
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Commercial |
$127.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Healthscope Commercial |
$131.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.15
|
| Rate for Payer: Mclaren Commercial |
$121.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Nomi Health Commercial |
$110.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.93
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.01 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: Aetna Commercial |
$121.64
|
| Rate for Payer: Aetna Medicare |
$50.01
|
| Rate for Payer: ASR ASR |
$131.10
|
| Rate for Payer: BCBS Complete |
$54.06
|
| Rate for Payer: BCBS Trust/PPO |
$111.43
|
| Rate for Payer: BCN Commercial |
$111.43
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Commercial |
$127.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Healthscope Commercial |
$131.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.15
|
| Rate for Payer: Mclaren Commercial |
$121.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Nomi Health Commercial |
$110.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.42
|
| Rate for Payer: Priority Health Narrow Network |
$94.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.93
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,145.31 |
| Max. Negotiated Rate |
$1,527.08 |
| Rate for Payer: Aetna Commercial |
$1,374.37
|
| Rate for Payer: ASR ASR |
$1,481.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.04
|
| Rate for Payer: BCN Commercial |
$1,254.04
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Commercial |
$1,435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Healthscope Commercial |
$1,481.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,527.08
|
| Rate for Payer: Mclaren Commercial |
$1,374.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Nomi Health Commercial |
$1,252.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,343.83
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$565.02 |
| Max. Negotiated Rate |
$1,527.08 |
| Rate for Payer: Aetna Commercial |
$1,374.37
|
| Rate for Payer: Aetna Medicare |
$565.02
|
| Rate for Payer: ASR ASR |
$1,481.27
|
| Rate for Payer: BCBS Complete |
$610.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.08
|
| Rate for Payer: BCN Commercial |
$1,259.08
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Commercial |
$1,435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Healthscope Commercial |
$1,481.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,527.08
|
| Rate for Payer: Mclaren Commercial |
$1,374.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,221.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Nomi Health Commercial |
$1,252.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,338.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,070.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,343.83
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.79 |
| Max. Negotiated Rate |
$150.39 |
| Rate for Payer: Aetna Commercial |
$135.35
|
| Rate for Payer: ASR ASR |
$145.88
|
| Rate for Payer: BCBS Trust/PPO |
$123.50
|
| Rate for Payer: BCN Commercial |
$123.50
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$145.88
|
| Rate for Payer: Healthscope Whirlpool |
$150.39
|
| Rate for Payer: Mclaren Commercial |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$123.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.34
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$150.39 |
| Rate for Payer: Aetna Commercial |
$135.35
|
| Rate for Payer: Aetna Medicare |
$55.64
|
| Rate for Payer: ASR ASR |
$145.88
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$124.00
|
| Rate for Payer: BCN Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$145.88
|
| Rate for Payer: Healthscope Whirlpool |
$150.39
|
| Rate for Payer: Mclaren Commercial |
$135.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$123.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.77
|
| Rate for Payer: Priority Health Narrow Network |
$105.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.34
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.48 |
| Max. Negotiated Rate |
$348.64 |
| Rate for Payer: Aetna Commercial |
$313.78
|
| Rate for Payer: ASR ASR |
$338.18
|
| Rate for Payer: BCBS Trust/PPO |
$286.30
|
| Rate for Payer: BCN Commercial |
$286.30
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$327.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Healthscope Commercial |
$338.18
|
| Rate for Payer: Healthscope Whirlpool |
$348.64
|
| Rate for Payer: Mclaren Commercial |
$313.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Nomi Health Commercial |
$285.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.80
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$348.64 |
| Rate for Payer: Aetna Commercial |
$313.78
|
| Rate for Payer: Aetna Medicare |
$129.00
|
| Rate for Payer: ASR ASR |
$338.18
|
| Rate for Payer: BCBS Complete |
$139.46
|
| Rate for Payer: BCBS Trust/PPO |
$287.45
|
| Rate for Payer: BCN Commercial |
$287.45
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$327.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Healthscope Commercial |
$338.18
|
| Rate for Payer: Healthscope Whirlpool |
$348.64
|
| Rate for Payer: Mclaren Commercial |
$313.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Nomi Health Commercial |
$285.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$305.48
|
| Rate for Payer: Priority Health Narrow Network |
$244.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.80
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$308.06 |
| Rate for Payer: Aetna Commercial |
$277.25
|
| Rate for Payer: ASR ASR |
$298.82
|
| Rate for Payer: BCBS Trust/PPO |
$252.98
|
| Rate for Payer: BCN Commercial |
$252.98
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Healthscope Commercial |
$298.82
|
| Rate for Payer: Healthscope Whirlpool |
$308.06
|
| Rate for Payer: Mclaren Commercial |
$277.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Nomi Health Commercial |
$252.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.09
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$308.06 |
| Rate for Payer: Aetna Commercial |
$277.25
|
| Rate for Payer: Aetna Medicare |
$113.98
|
| Rate for Payer: ASR ASR |
$298.82
|
| Rate for Payer: BCBS Complete |
$123.22
|
| Rate for Payer: BCBS Trust/PPO |
$254.00
|
| Rate for Payer: BCN Commercial |
$254.00
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Healthscope Commercial |
$298.82
|
| Rate for Payer: Healthscope Whirlpool |
$308.06
|
| Rate for Payer: Mclaren Commercial |
$277.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Nomi Health Commercial |
$252.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$269.92
|
| Rate for Payer: Priority Health Narrow Network |
$215.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.09
|
|
