|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Aetna Commercial |
$88.17
|
| Rate for Payer: Aetna Medicare |
$36.25
|
| Rate for Payer: ASR ASR |
$95.03
|
| Rate for Payer: BCBS Complete |
$39.19
|
| Rate for Payer: BCBS Trust/PPO |
$80.78
|
| Rate for Payer: BCN Commercial |
$80.78
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$92.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Healthscope Commercial |
$95.03
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Mclaren Commercial |
$88.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Nomi Health Commercial |
$80.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.84
|
| Rate for Payer: Priority Health Narrow Network |
$68.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.21
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.48 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Aetna Commercial |
$88.17
|
| Rate for Payer: ASR ASR |
$95.03
|
| Rate for Payer: BCBS Trust/PPO |
$80.45
|
| Rate for Payer: BCN Commercial |
$80.45
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$92.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Healthscope Commercial |
$95.03
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Mclaren Commercial |
$88.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Nomi Health Commercial |
$80.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.21
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.17 |
| Max. Negotiated Rate |
$1,143.70 |
| Rate for Payer: Aetna Commercial |
$1,029.33
|
| Rate for Payer: Aetna Medicare |
$423.17
|
| Rate for Payer: ASR ASR |
$1,109.39
|
| Rate for Payer: BCBS Complete |
$457.48
|
| Rate for Payer: BCBS Trust/PPO |
$942.98
|
| Rate for Payer: BCN Commercial |
$942.98
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Commercial |
$1,075.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,109.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.70
|
| Rate for Payer: Mclaren Commercial |
$1,029.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$914.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Nomi Health Commercial |
$937.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,002.11
|
| Rate for Payer: Priority Health Narrow Network |
$801.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.46
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$857.77 |
| Max. Negotiated Rate |
$1,143.70 |
| Rate for Payer: Aetna Commercial |
$1,029.33
|
| Rate for Payer: ASR ASR |
$1,109.39
|
| Rate for Payer: BCBS Trust/PPO |
$939.21
|
| Rate for Payer: BCN Commercial |
$939.21
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Commercial |
$1,075.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,109.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.70
|
| Rate for Payer: Mclaren Commercial |
$1,029.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Nomi Health Commercial |
$937.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.46
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$963.15 |
| Max. Negotiated Rate |
$1,284.20 |
| Rate for Payer: Aetna Commercial |
$1,155.78
|
| Rate for Payer: ASR ASR |
$1,245.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.59
|
| Rate for Payer: BCN Commercial |
$1,054.59
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Commercial |
$1,207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,245.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,284.20
|
| Rate for Payer: Mclaren Commercial |
$1,155.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Nomi Health Commercial |
$1,053.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.10
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$1,284.20 |
| Rate for Payer: Aetna Commercial |
$1,155.78
|
| Rate for Payer: Aetna Medicare |
$475.15
|
| Rate for Payer: ASR ASR |
$1,245.67
|
| Rate for Payer: BCBS Complete |
$513.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.82
|
| Rate for Payer: BCN Commercial |
$1,058.82
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Commercial |
$1,207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,245.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,284.20
|
| Rate for Payer: Mclaren Commercial |
$1,155.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Nomi Health Commercial |
$1,053.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,125.22
|
| Rate for Payer: Priority Health Narrow Network |
$900.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.10
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.20 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$404.20
|
| Rate for Payer: ASR ASR |
$1,059.65
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: BCBS Trust/PPO |
$900.70
|
| Rate for Payer: BCN Commercial |
$900.70
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$1,059.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.42
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$957.18
|
| Rate for Payer: Priority Health Narrow Network |
$765.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$819.32 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: ASR ASR |
$1,059.65
|
| Rate for Payer: BCBS Trust/PPO |
$897.10
|
| Rate for Payer: BCN Commercial |
$897.10
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$1,059.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.42
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,500.28 |
| Max. Negotiated Rate |
$6,000.38 |
| Rate for Payer: Aetna Commercial |
$5,400.34
|
| Rate for Payer: ASR ASR |
$5,820.37
|
| Rate for Payer: BCBS Trust/PPO |
$4,927.51
|
| Rate for Payer: BCN Commercial |
$4,927.51
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Commercial |
$5,640.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,820.37
|
| Rate for Payer: Healthscope Whirlpool |
$6,000.38
|
| Rate for Payer: Mclaren Commercial |
$5,400.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Nomi Health Commercial |
$4,920.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,280.33
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,220.14 |
| Max. Negotiated Rate |
$6,000.38 |
| Rate for Payer: Aetna Commercial |
$5,400.34
|
| Rate for Payer: Aetna Medicare |
$2,220.14
|
| Rate for Payer: ASR ASR |
$5,820.37
|
| Rate for Payer: BCBS Complete |
$2,400.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,947.31
|
| Rate for Payer: BCN Commercial |
$4,947.31
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Commercial |
$5,640.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,820.37
|
| Rate for Payer: Healthscope Whirlpool |
$6,000.38
|
| Rate for Payer: Mclaren Commercial |
$5,400.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,800.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Nomi Health Commercial |
$4,920.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,257.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,206.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,280.33
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,133.78 |
| Max. Negotiated Rate |
$1,511.70 |
| Rate for Payer: Aetna Commercial |
$1,360.53
|
| Rate for Payer: ASR ASR |
$1,466.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.41
|
| Rate for Payer: BCN Commercial |
$1,241.41
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Commercial |
$1,421.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,466.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,511.70
|
| Rate for Payer: Mclaren Commercial |
$1,360.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Nomi Health Commercial |
$1,239.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.30
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$559.33 |
| Max. Negotiated Rate |
$1,511.70 |
| Rate for Payer: Aetna Commercial |
$1,360.53
|
| Rate for Payer: Aetna Medicare |
$559.33
|
| Rate for Payer: ASR ASR |
$1,466.35
|
| Rate for Payer: BCBS Complete |
$604.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.40
|
| Rate for Payer: BCN Commercial |
$1,246.40
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Commercial |
$1,421.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,466.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,511.70
|
| Rate for Payer: Mclaren Commercial |
$1,360.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,209.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Nomi Health Commercial |
$1,239.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,324.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,059.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,330.30
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$252.82
|
| Rate for Payer: Aetna Medicare |
$103.94
|
| Rate for Payer: ASR ASR |
$272.48
|
| Rate for Payer: BCBS Complete |
$112.36
|
| Rate for Payer: BCBS Trust/PPO |
$231.61
|
| Rate for Payer: BCN Commercial |
$231.61
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Commercial |
$264.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Healthscope Whirlpool |
$280.91
|
| Rate for Payer: Mclaren Commercial |
$252.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Nomi Health Commercial |
$230.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$246.13
|
| Rate for Payer: Priority Health Narrow Network |
$196.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.20
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$252.82
|
| Rate for Payer: ASR ASR |
$272.48
|
| Rate for Payer: BCBS Trust/PPO |
$230.68
|
| Rate for Payer: BCN Commercial |
$230.68
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Commercial |
$264.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Healthscope Whirlpool |
$280.91
|
| Rate for Payer: Mclaren Commercial |
$252.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Nomi Health Commercial |
$230.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.20
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$58.95
|
| Rate for Payer: BCN Commercial |
$58.95
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$69.64
|
| Rate for Payer: Healthscope Whirlpool |
$71.79
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: Aetna Medicare |
$26.56
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: BCBS Complete |
$28.72
|
| Rate for Payer: BCBS Trust/PPO |
$59.19
|
| Rate for Payer: BCN Commercial |
$59.19
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$69.64
|
| Rate for Payer: Healthscope Whirlpool |
$71.79
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.90
|
| Rate for Payer: Priority Health Narrow Network |
$50.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.44 |
| Max. Negotiated Rate |
$1,098.49 |
| Rate for Payer: Aetna Commercial |
$988.64
|
| Rate for Payer: Aetna Medicare |
$406.44
|
| Rate for Payer: ASR ASR |
$1,065.54
|
| Rate for Payer: BCBS Complete |
$439.40
|
| Rate for Payer: BCBS Trust/PPO |
$905.71
|
| Rate for Payer: BCN Commercial |
$905.71
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Commercial |
$1,032.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Healthscope Commercial |
$1,065.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,098.49
|
| Rate for Payer: Mclaren Commercial |
$988.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$878.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Nomi Health Commercial |
$900.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$962.50
|
| Rate for Payer: Priority Health Narrow Network |
$770.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$966.67
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$823.87 |
| Max. Negotiated Rate |
$1,098.49 |
| Rate for Payer: Aetna Commercial |
$988.64
|
| Rate for Payer: ASR ASR |
$1,065.54
|
| Rate for Payer: BCBS Trust/PPO |
$902.08
|
| Rate for Payer: BCN Commercial |
$902.08
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Commercial |
$1,032.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Healthscope Commercial |
$1,065.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,098.49
|
| Rate for Payer: Mclaren Commercial |
$988.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Nomi Health Commercial |
$900.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$966.67
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.69 |
| Max. Negotiated Rate |
$712.67 |
| Rate for Payer: Aetna Commercial |
$641.40
|
| Rate for Payer: Aetna Medicare |
$263.69
|
| Rate for Payer: ASR ASR |
$691.29
|
| Rate for Payer: BCBS Complete |
$285.07
|
| Rate for Payer: BCBS Trust/PPO |
$587.60
|
| Rate for Payer: BCN Commercial |
$587.60
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Commercial |
$669.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Healthscope Commercial |
$691.29
|
| Rate for Payer: Healthscope Whirlpool |
$712.67
|
| Rate for Payer: Mclaren Commercial |
$641.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Nomi Health Commercial |
$584.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$624.44
|
| Rate for Payer: Priority Health Narrow Network |
$499.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.15
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.50 |
| Max. Negotiated Rate |
$712.67 |
| Rate for Payer: Aetna Commercial |
$641.40
|
| Rate for Payer: ASR ASR |
$691.29
|
| Rate for Payer: BCBS Trust/PPO |
$585.24
|
| Rate for Payer: BCN Commercial |
$585.24
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Commercial |
$669.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Healthscope Commercial |
$691.29
|
| Rate for Payer: Healthscope Whirlpool |
$712.67
|
| Rate for Payer: Mclaren Commercial |
$641.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Nomi Health Commercial |
$584.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.15
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna Commercial |
$183.53
|
| Rate for Payer: ASR ASR |
$197.80
|
| Rate for Payer: BCBS Trust/PPO |
$167.46
|
| Rate for Payer: BCN Commercial |
$167.46
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$191.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Healthscope Commercial |
$197.80
|
| Rate for Payer: Healthscope Whirlpool |
$203.92
|
| Rate for Payer: Mclaren Commercial |
$183.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$167.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.45
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna Commercial |
$183.53
|
| Rate for Payer: Aetna Medicare |
$75.45
|
| Rate for Payer: ASR ASR |
$197.80
|
| Rate for Payer: BCBS Complete |
$81.57
|
| Rate for Payer: BCBS Trust/PPO |
$168.13
|
| Rate for Payer: BCN Commercial |
$168.13
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$191.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Healthscope Commercial |
$197.80
|
| Rate for Payer: Healthscope Whirlpool |
$203.92
|
| Rate for Payer: Mclaren Commercial |
$183.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$167.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$178.67
|
| Rate for Payer: Priority Health Narrow Network |
$142.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.45
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$431.11
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.51 |
| Max. Negotiated Rate |
$431.11 |
| Rate for Payer: Aetna Commercial |
$388.00
|
| Rate for Payer: Aetna Medicare |
$159.51
|
| Rate for Payer: ASR ASR |
$418.18
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: BCBS Trust/PPO |
$355.45
|
| Rate for Payer: BCN Commercial |
$355.45
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cofinity Commercial |
$405.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.89
|
| Rate for Payer: Healthscope Commercial |
$418.18
|
| Rate for Payer: Healthscope Whirlpool |
$431.11
|
| Rate for Payer: Mclaren Commercial |
$388.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.44
|
| Rate for Payer: Nomi Health Commercial |
$353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$377.74
|
| Rate for Payer: Priority Health Narrow Network |
$302.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.38
|
|
