|
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
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.41 |
| Max. Negotiated Rate |
$517.32 |
| Rate for Payer: Aetna Commercial |
$465.59
|
| Rate for Payer: Aetna Medicare |
$191.41
|
| Rate for Payer: ASR ASR |
$501.80
|
| Rate for Payer: BCBS Complete |
$206.93
|
| Rate for Payer: BCBS Trust/PPO |
$426.53
|
| Rate for Payer: BCN Commercial |
$426.53
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Commercial |
$486.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Healthscope Commercial |
$501.80
|
| Rate for Payer: Healthscope Whirlpool |
$517.32
|
| Rate for Payer: Mclaren Commercial |
$465.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Nomi Health Commercial |
$424.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$453.28
|
| Rate for Payer: Priority Health Narrow Network |
$362.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.24
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.99 |
| Max. Negotiated Rate |
$517.32 |
| Rate for Payer: Aetna Commercial |
$465.59
|
| Rate for Payer: ASR ASR |
$501.80
|
| Rate for Payer: BCBS Trust/PPO |
$424.82
|
| Rate for Payer: BCN Commercial |
$424.82
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Commercial |
$486.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Healthscope Commercial |
$501.80
|
| Rate for Payer: Healthscope Whirlpool |
$517.32
|
| Rate for Payer: Mclaren Commercial |
$465.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Nomi Health Commercial |
$424.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.24
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$305.88 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: Aetna Medicare |
$113.18
|
| Rate for Payer: ASR ASR |
$296.70
|
| Rate for Payer: BCBS Complete |
$122.35
|
| Rate for Payer: BCBS Trust/PPO |
$252.20
|
| Rate for Payer: BCN Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$287.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$296.70
|
| Rate for Payer: Healthscope Whirlpool |
$305.88
|
| Rate for Payer: Mclaren Commercial |
$275.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Nomi Health Commercial |
$250.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$268.01
|
| Rate for Payer: Priority Health Narrow Network |
$214.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.17
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.41 |
| Max. Negotiated Rate |
$305.88 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: ASR ASR |
$296.70
|
| Rate for Payer: BCBS Trust/PPO |
$251.19
|
| Rate for Payer: BCN Commercial |
$251.19
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$287.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$296.70
|
| Rate for Payer: Healthscope Whirlpool |
$305.88
|
| Rate for Payer: Mclaren Commercial |
$275.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Nomi Health Commercial |
$250.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.17
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$393.18 |
| Max. Negotiated Rate |
$524.24 |
| Rate for Payer: Aetna Commercial |
$471.82
|
| Rate for Payer: ASR ASR |
$508.51
|
| Rate for Payer: BCBS Trust/PPO |
$430.51
|
| Rate for Payer: BCN Commercial |
$430.51
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Commercial |
$492.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Healthscope Commercial |
$508.51
|
| Rate for Payer: Healthscope Whirlpool |
$524.24
|
| Rate for Payer: Mclaren Commercial |
$471.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Nomi Health Commercial |
$429.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.33
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.97 |
| Max. Negotiated Rate |
$524.24 |
| Rate for Payer: Aetna Commercial |
$471.82
|
| Rate for Payer: Aetna Medicare |
$193.97
|
| Rate for Payer: ASR ASR |
$508.51
|
| Rate for Payer: BCBS Complete |
$209.70
|
| Rate for Payer: BCBS Trust/PPO |
$432.24
|
| Rate for Payer: BCN Commercial |
$432.24
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Commercial |
$492.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Healthscope Commercial |
$508.51
|
| Rate for Payer: Healthscope Whirlpool |
$524.24
|
| Rate for Payer: Mclaren Commercial |
$471.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Nomi Health Commercial |
$429.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.34
|
| Rate for Payer: Priority Health Narrow Network |
$367.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.33
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.81 |
| Max. Negotiated Rate |
$429.21 |
| Rate for Payer: Aetna Commercial |
$386.29
|
| Rate for Payer: Aetna Medicare |
$158.81
|
| Rate for Payer: ASR ASR |
$416.33
|
| Rate for Payer: BCBS Complete |
$171.68
|
| Rate for Payer: BCBS Trust/PPO |
$353.88
|
| Rate for Payer: BCN Commercial |
$353.88
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Commercial |
$403.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Healthscope Commercial |
$416.33
|
| Rate for Payer: Healthscope Whirlpool |
$429.21
|
| Rate for Payer: Mclaren Commercial |
$386.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Nomi Health Commercial |
$351.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$376.07
|
| Rate for Payer: Priority Health Narrow Network |
$300.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.70
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.91 |
| Max. Negotiated Rate |
$429.21 |
| Rate for Payer: Aetna Commercial |
$386.29
|
| Rate for Payer: ASR ASR |
$416.33
|
| Rate for Payer: BCBS Trust/PPO |
$352.47
|
| Rate for Payer: BCN Commercial |
$352.47
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Commercial |
$403.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Healthscope Commercial |
$416.33
|
| Rate for Payer: Healthscope Whirlpool |
$429.21
|
| Rate for Payer: Mclaren Commercial |
$386.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Nomi Health Commercial |
$351.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.70
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: BCBS Trust/PPO |
$153.79
|
| Rate for Payer: BCN Commercial |
$153.79
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$181.65
|
| Rate for Payer: Healthscope Whirlpool |
$187.27
|
| Rate for Payer: Mclaren Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: Aetna Medicare |
$69.29
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: BCBS Trust/PPO |
$154.40
|
| Rate for Payer: BCN Commercial |
$154.40
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$181.65
|
| Rate for Payer: Healthscope Whirlpool |
$187.27
|
| Rate for Payer: Mclaren Commercial |
$168.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.09
|
| Rate for Payer: Priority Health Narrow Network |
$131.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$107.23
|
| Rate for Payer: BCN Commercial |
$107.23
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.95
|
| Rate for Payer: Priority Health Narrow Network |
$91.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Trust/PPO |
$106.80
|
| Rate for Payer: BCN Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.38 |
| Max. Negotiated Rate |
$263.18 |
| Rate for Payer: Aetna Commercial |
$236.86
|
| Rate for Payer: ASR ASR |
$255.28
|
| Rate for Payer: BCBS Trust/PPO |
$216.12
|
| Rate for Payer: BCN Commercial |
$216.12
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Commercial |
$247.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Healthscope Whirlpool |
$263.18
|
| Rate for Payer: Mclaren Commercial |
$236.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Nomi Health Commercial |
$215.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.60
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$263.18 |
| Rate for Payer: Aetna Commercial |
$236.86
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: ASR ASR |
$255.28
|
| Rate for Payer: BCBS Complete |
$105.27
|
| Rate for Payer: BCBS Trust/PPO |
$216.99
|
| Rate for Payer: BCN Commercial |
$216.99
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Commercial |
$247.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Healthscope Whirlpool |
$263.18
|
| Rate for Payer: Mclaren Commercial |
$236.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Nomi Health Commercial |
$215.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.60
|
| Rate for Payer: Priority Health Narrow Network |
$184.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.60
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$697.31 |
| Max. Negotiated Rate |
$1,884.62 |
| Rate for Payer: Aetna Commercial |
$1,696.16
|
| Rate for Payer: Aetna Medicare |
$697.31
|
| Rate for Payer: ASR ASR |
$1,828.08
|
| Rate for Payer: BCBS Complete |
$753.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.87
|
| Rate for Payer: BCN Commercial |
$1,553.87
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Commercial |
$1,771.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,828.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.62
|
| Rate for Payer: Mclaren Commercial |
$1,696.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,507.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Nomi Health Commercial |
$1,545.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,651.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,321.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,658.47
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,413.46 |
| Max. Negotiated Rate |
$1,884.62 |
| Rate for Payer: Aetna Commercial |
$1,696.16
|
| Rate for Payer: ASR ASR |
$1,828.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,547.65
|
| Rate for Payer: BCN Commercial |
$1,547.65
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Commercial |
$1,771.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,828.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.62
|
| Rate for Payer: Mclaren Commercial |
$1,696.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Nomi Health Commercial |
$1,545.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,658.47
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$637.30 |
| Max. Negotiated Rate |
$849.73 |
| Rate for Payer: Aetna Commercial |
$764.76
|
| Rate for Payer: ASR ASR |
$824.24
|
| Rate for Payer: BCBS Trust/PPO |
$697.80
|
| Rate for Payer: BCN Commercial |
$697.80
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Commercial |
$798.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$824.24
|
| Rate for Payer: Healthscope Whirlpool |
$849.73
|
| Rate for Payer: Mclaren Commercial |
$764.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Nomi Health Commercial |
$696.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.76
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$849.73 |
| Rate for Payer: Aetna Commercial |
$764.76
|
| Rate for Payer: Aetna Medicare |
$314.40
|
| Rate for Payer: ASR ASR |
$824.24
|
| Rate for Payer: BCBS Complete |
$339.89
|
| Rate for Payer: BCBS Trust/PPO |
$700.60
|
| Rate for Payer: BCN Commercial |
$700.60
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Commercial |
$798.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$824.24
|
| Rate for Payer: Healthscope Whirlpool |
$849.73
|
| Rate for Payer: Mclaren Commercial |
$764.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$679.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Nomi Health Commercial |
$696.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$744.53
|
| Rate for Payer: Priority Health Narrow Network |
$595.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.76
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.53 |
| Max. Negotiated Rate |
$977.12 |
| Rate for Payer: Aetna Commercial |
$879.41
|
| Rate for Payer: Aetna Medicare |
$361.53
|
| Rate for Payer: ASR ASR |
$947.81
|
| Rate for Payer: BCBS Complete |
$390.85
|
| Rate for Payer: BCBS Trust/PPO |
$805.64
|
| Rate for Payer: BCN Commercial |
$805.64
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Commercial |
$918.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$947.81
|
| Rate for Payer: Healthscope Whirlpool |
$977.12
|
| Rate for Payer: Mclaren Commercial |
$879.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Nomi Health Commercial |
$801.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$856.15
|
| Rate for Payer: Priority Health Narrow Network |
$684.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$859.87
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$732.84 |
| Max. Negotiated Rate |
$977.12 |
| Rate for Payer: Aetna Commercial |
$879.41
|
| Rate for Payer: ASR ASR |
$947.81
|
| Rate for Payer: BCBS Trust/PPO |
$802.41
|
| Rate for Payer: BCN Commercial |
$802.41
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Commercial |
$918.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$947.81
|
| Rate for Payer: Healthscope Whirlpool |
$977.12
|
| Rate for Payer: Mclaren Commercial |
$879.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Nomi Health Commercial |
$801.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$859.87
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,876.06 |
| Max. Negotiated Rate |
$5,070.44 |
| Rate for Payer: Aetna Commercial |
$4,563.40
|
| Rate for Payer: Aetna Medicare |
$1,876.06
|
| Rate for Payer: ASR ASR |
$4,918.33
|
| Rate for Payer: BCBS Complete |
$2,028.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,180.58
|
| Rate for Payer: BCN Commercial |
$4,180.58
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Commercial |
$4,766.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,918.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,070.44
|
| Rate for Payer: Mclaren Commercial |
$4,563.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,056.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Nomi Health Commercial |
$4,157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,442.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,554.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,461.99
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,802.83 |
| Max. Negotiated Rate |
$5,070.44 |
| Rate for Payer: Aetna Commercial |
$4,563.40
|
| Rate for Payer: ASR ASR |
$4,918.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,163.85
|
| Rate for Payer: BCN Commercial |
$4,163.85
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Commercial |
$4,766.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,918.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,070.44
|
| Rate for Payer: Mclaren Commercial |
$4,563.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Nomi Health Commercial |
$4,157.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,461.99
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,059.81 |
| Max. Negotiated Rate |
$1,413.08 |
| Rate for Payer: Aetna Commercial |
$1,271.77
|
| Rate for Payer: ASR ASR |
$1,370.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.42
|
| Rate for Payer: BCN Commercial |
$1,160.42
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Commercial |
$1,328.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,370.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.08
|
| Rate for Payer: Mclaren Commercial |
$1,271.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Nomi Health Commercial |
$1,158.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.51
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.84 |
| Max. Negotiated Rate |
$1,413.08 |
| Rate for Payer: Aetna Commercial |
$1,271.77
|
| Rate for Payer: Aetna Medicare |
$522.84
|
| Rate for Payer: ASR ASR |
$1,370.69
|
| Rate for Payer: BCBS Complete |
$565.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.08
|
| Rate for Payer: BCN Commercial |
$1,165.08
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Commercial |
$1,328.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,370.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,413.08
|
| Rate for Payer: Mclaren Commercial |
$1,271.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,130.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Nomi Health Commercial |
$1,158.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,238.14
|
| Rate for Payer: Priority Health Narrow Network |
$990.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.51
|
|
