|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$411.49 |
| Max. Negotiated Rate |
$548.65 |
| Rate for Payer: Aetna Commercial |
$493.79
|
| Rate for Payer: ASR ASR |
$532.19
|
| Rate for Payer: BCBS Trust/PPO |
$450.55
|
| Rate for Payer: BCN Commercial |
$450.55
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Commercial |
$515.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$532.19
|
| Rate for Payer: Healthscope Whirlpool |
$548.65
|
| Rate for Payer: Mclaren Commercial |
$493.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Nomi Health Commercial |
$449.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.81
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$61.87 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: ASR ASR |
$60.01
|
| Rate for Payer: BCBS Trust/PPO |
$50.81
|
| Rate for Payer: BCN Commercial |
$50.81
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$60.01
|
| Rate for Payer: Healthscope Whirlpool |
$61.87
|
| Rate for Payer: Mclaren Commercial |
$55.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Nomi Health Commercial |
$50.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.45
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$61.87 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: ASR ASR |
$60.01
|
| Rate for Payer: BCBS Complete |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.01
|
| Rate for Payer: BCN Commercial |
$51.01
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$60.01
|
| Rate for Payer: Healthscope Whirlpool |
$61.87
|
| Rate for Payer: Mclaren Commercial |
$55.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Nomi Health Commercial |
$50.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.21
|
| Rate for Payer: Priority Health Narrow Network |
$43.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.45
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$321.97 |
| Rate for Payer: Aetna Commercial |
$289.77
|
| Rate for Payer: Aetna Medicare |
$119.13
|
| Rate for Payer: ASR ASR |
$312.31
|
| Rate for Payer: BCBS Complete |
$128.79
|
| Rate for Payer: BCBS Trust/PPO |
$265.46
|
| Rate for Payer: BCN Commercial |
$265.46
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Commercial |
$302.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$312.31
|
| Rate for Payer: Healthscope Whirlpool |
$321.97
|
| Rate for Payer: Mclaren Commercial |
$289.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Nomi Health Commercial |
$264.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.11
|
| Rate for Payer: Priority Health Narrow Network |
$225.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.33
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$321.97 |
| Rate for Payer: Aetna Commercial |
$289.77
|
| Rate for Payer: ASR ASR |
$312.31
|
| Rate for Payer: BCBS Trust/PPO |
$264.40
|
| Rate for Payer: BCN Commercial |
$264.40
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Commercial |
$302.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$312.31
|
| Rate for Payer: Healthscope Whirlpool |
$321.97
|
| Rate for Payer: Mclaren Commercial |
$289.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Nomi Health Commercial |
$264.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.33
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$160.24 |
| Rate for Payer: Aetna Commercial |
$144.22
|
| Rate for Payer: Aetna Medicare |
$59.29
|
| Rate for Payer: ASR ASR |
$155.43
|
| Rate for Payer: BCBS Complete |
$64.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.12
|
| Rate for Payer: BCN Commercial |
$132.12
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$155.43
|
| Rate for Payer: Healthscope Whirlpool |
$160.24
|
| Rate for Payer: Mclaren Commercial |
$144.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.40
|
| Rate for Payer: Priority Health Narrow Network |
$112.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.01
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$160.24 |
| Rate for Payer: Aetna Commercial |
$144.22
|
| Rate for Payer: ASR ASR |
$155.43
|
| Rate for Payer: BCBS Trust/PPO |
$131.59
|
| Rate for Payer: BCN Commercial |
$131.59
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$155.43
|
| Rate for Payer: Healthscope Whirlpool |
$160.24
|
| Rate for Payer: Mclaren Commercial |
$144.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.01
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$112.74 |
| Rate for Payer: Aetna Commercial |
$101.47
|
| Rate for Payer: Aetna Medicare |
$41.71
|
| Rate for Payer: ASR ASR |
$109.36
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$92.95
|
| Rate for Payer: BCN Commercial |
$92.95
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$105.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$109.36
|
| Rate for Payer: Healthscope Whirlpool |
$112.74
|
| Rate for Payer: Mclaren Commercial |
$101.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Nomi Health Commercial |
$92.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.78
|
| Rate for Payer: Priority Health Narrow Network |
$79.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.21
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$112.74 |
| Rate for Payer: Aetna Commercial |
$101.47
|
| Rate for Payer: ASR ASR |
$109.36
|
| Rate for Payer: BCBS Trust/PPO |
$92.58
|
| Rate for Payer: BCN Commercial |
$92.58
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$105.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$109.36
|
| Rate for Payer: Healthscope Whirlpool |
$112.74
|
| Rate for Payer: Mclaren Commercial |
$101.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Nomi Health Commercial |
$92.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.21
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$100.39 |
| Rate for Payer: Aetna Commercial |
$90.35
|
| Rate for Payer: ASR ASR |
$97.38
|
| Rate for Payer: BCBS Trust/PPO |
$82.44
|
| Rate for Payer: BCN Commercial |
$82.44
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Healthscope Whirlpool |
$100.39
|
| Rate for Payer: Mclaren Commercial |
$90.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Nomi Health Commercial |
$82.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.34
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$100.39 |
| Rate for Payer: Aetna Commercial |
$90.35
|
| Rate for Payer: Aetna Medicare |
$37.14
|
| Rate for Payer: ASR ASR |
$97.38
|
| Rate for Payer: BCBS Complete |
$40.16
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Healthscope Whirlpool |
$100.39
|
| Rate for Payer: Mclaren Commercial |
$90.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Nomi Health Commercial |
$82.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.96
|
| Rate for Payer: Priority Health Narrow Network |
$70.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.34
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.83 |
| Max. Negotiated Rate |
$3,329.28 |
| Rate for Payer: Aetna Commercial |
$2,996.35
|
| Rate for Payer: Aetna Medicare |
$1,231.83
|
| Rate for Payer: ASR ASR |
$3,229.40
|
| Rate for Payer: BCBS Complete |
$1,331.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,744.99
|
| Rate for Payer: BCN Commercial |
$2,744.99
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Commercial |
$3,129.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$3,229.40
|
| Rate for Payer: Healthscope Whirlpool |
$3,329.28
|
| Rate for Payer: Mclaren Commercial |
$2,996.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,663.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Nomi Health Commercial |
$2,730.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,917.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,333.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,929.77
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,496.96 |
| Max. Negotiated Rate |
$3,329.28 |
| Rate for Payer: Aetna Commercial |
$2,996.35
|
| Rate for Payer: ASR ASR |
$3,229.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,734.00
|
| Rate for Payer: BCN Commercial |
$2,734.00
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Commercial |
$3,129.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$3,229.40
|
| Rate for Payer: Healthscope Whirlpool |
$3,329.28
|
| Rate for Payer: Mclaren Commercial |
$2,996.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Nomi Health Commercial |
$2,730.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,929.77
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,307.76 |
| Max. Negotiated Rate |
$3,077.01 |
| Rate for Payer: Aetna Commercial |
$2,769.31
|
| Rate for Payer: ASR ASR |
$2,984.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.84
|
| Rate for Payer: BCN Commercial |
$2,526.84
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Commercial |
$2,892.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,984.70
|
| Rate for Payer: Healthscope Whirlpool |
$3,077.01
|
| Rate for Payer: Mclaren Commercial |
$2,769.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Nomi Health Commercial |
$2,523.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,707.77
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,138.49 |
| Max. Negotiated Rate |
$3,077.01 |
| Rate for Payer: Aetna Commercial |
$2,769.31
|
| Rate for Payer: Aetna Medicare |
$1,138.49
|
| Rate for Payer: ASR ASR |
$2,984.70
|
| Rate for Payer: BCBS Complete |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,536.99
|
| Rate for Payer: BCN Commercial |
$2,536.99
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Commercial |
$2,892.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,984.70
|
| Rate for Payer: Healthscope Whirlpool |
$3,077.01
|
| Rate for Payer: Mclaren Commercial |
$2,769.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,461.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Nomi Health Commercial |
$2,523.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,696.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,156.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,707.77
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,532.71 |
| Max. Negotiated Rate |
$2,043.61 |
| Rate for Payer: Aetna Commercial |
$1,839.25
|
| Rate for Payer: ASR ASR |
$1,982.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,678.21
|
| Rate for Payer: BCN Commercial |
$1,678.21
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Commercial |
$1,920.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,982.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,043.61
|
| Rate for Payer: Mclaren Commercial |
$1,839.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Nomi Health Commercial |
$1,675.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,798.38
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$2,043.61 |
| Rate for Payer: Aetna Commercial |
$1,839.25
|
| Rate for Payer: Aetna Medicare |
$756.14
|
| Rate for Payer: ASR ASR |
$1,982.30
|
| Rate for Payer: BCBS Complete |
$817.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.96
|
| Rate for Payer: BCN Commercial |
$1,684.96
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Commercial |
$1,920.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,982.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,043.61
|
| Rate for Payer: Mclaren Commercial |
$1,839.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,634.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Nomi Health Commercial |
$1,675.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,790.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,798.38
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.67 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$40.16
|
| Rate for Payer: BCN Commercial |
$40.16
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$47.43
|
| Rate for Payer: Healthscope Whirlpool |
$48.90
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: BCBS Complete |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.32
|
| Rate for Payer: BCN Commercial |
$40.32
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$47.43
|
| Rate for Payer: Healthscope Whirlpool |
$48.90
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.85
|
| Rate for Payer: Priority Health Narrow Network |
$34.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$36.87 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: ASR ASR |
$35.76
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$34.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Healthscope Whirlpool |
$36.87
|
| Rate for Payer: Mclaren Commercial |
$33.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Nomi Health Commercial |
$30.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.31
|
| Rate for Payer: Priority Health Narrow Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.45
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$36.87 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: ASR ASR |
$35.76
|
| Rate for Payer: BCBS Trust/PPO |
$30.28
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$34.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Healthscope Whirlpool |
$36.87
|
| Rate for Payer: Mclaren Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Nomi Health Commercial |
$30.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.45
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.85 |
| Max. Negotiated Rate |
$150.47 |
| Rate for Payer: Aetna Commercial |
$135.42
|
| Rate for Payer: ASR ASR |
$145.96
|
| Rate for Payer: BCBS Trust/PPO |
$123.57
|
| Rate for Payer: BCN Commercial |
$123.57
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Commercial |
$141.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$150.47
|
| Rate for Payer: Mclaren Commercial |
$135.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Nomi Health Commercial |
$123.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.41
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$150.47 |
| Rate for Payer: Aetna Commercial |
$135.42
|
| Rate for Payer: Aetna Medicare |
$55.67
|
| Rate for Payer: ASR ASR |
$145.96
|
| Rate for Payer: BCBS Complete |
$60.19
|
| Rate for Payer: BCBS Trust/PPO |
$124.06
|
| Rate for Payer: BCN Commercial |
$124.06
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Commercial |
$141.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Healthscope Whirlpool |
$150.47
|
| Rate for Payer: Mclaren Commercial |
$135.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Nomi Health Commercial |
$123.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.84
|
| Rate for Payer: Priority Health Narrow Network |
$105.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.41
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: Aetna Commercial |
$311.36
|
| Rate for Payer: Aetna Medicare |
$128.00
|
| Rate for Payer: ASR ASR |
$335.57
|
| Rate for Payer: BCBS Complete |
$138.38
|
| Rate for Payer: BCBS Trust/PPO |
$285.24
|
| Rate for Payer: BCN Commercial |
$285.24
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Commercial |
$325.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$335.57
|
| Rate for Payer: Healthscope Whirlpool |
$345.95
|
| Rate for Payer: Mclaren Commercial |
$311.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Nomi Health Commercial |
$283.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$303.12
|
| Rate for Payer: Priority Health Narrow Network |
$242.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.44
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$259.46 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: Aetna Commercial |
$311.36
|
| Rate for Payer: ASR ASR |
$335.57
|
| Rate for Payer: BCBS Trust/PPO |
$284.09
|
| Rate for Payer: BCN Commercial |
$284.09
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Commercial |
$325.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$335.57
|
| Rate for Payer: Healthscope Whirlpool |
$345.95
|
| Rate for Payer: Mclaren Commercial |
$311.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Nomi Health Commercial |
$283.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.44
|
|
