|
HC BOWL
|
Facility
|
IP
|
$229.50
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: ASR ASR |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.96
|
|
|
HC BOWL
|
Facility
|
OP
|
$229.50
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: ASR ASR |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.09
|
| Rate for Payer: Priority Health Narrow Network |
$160.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.96
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
IP
|
$253.47
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.76 |
| Max. Negotiated Rate |
$253.47 |
| Rate for Payer: Aetna Commercial |
$228.12
|
| Rate for Payer: ASR ASR |
$245.87
|
| Rate for Payer: ASR Commercial |
$245.87
|
| Rate for Payer: BCBS Trust/PPO |
$206.55
|
| Rate for Payer: BCN Commercial |
$196.52
|
| Rate for Payer: Cash Price |
$202.78
|
| Rate for Payer: Cofinity Commercial |
$238.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.78
|
| Rate for Payer: Healthscope Commercial |
$253.47
|
| Rate for Payer: Healthscope Whirlpool |
$245.87
|
| Rate for Payer: Mclaren Commercial |
$228.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.45
|
| Rate for Payer: Nomi Health Commercial |
$207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.05
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
OP
|
$253.47
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$253.47 |
| Rate for Payer: Aetna Commercial |
$228.12
|
| Rate for Payer: Aetna Medicare |
$126.73
|
| Rate for Payer: ASR ASR |
$245.87
|
| Rate for Payer: ASR Commercial |
$245.87
|
| Rate for Payer: BCBS Complete |
$101.39
|
| Rate for Payer: BCBS Trust/PPO |
$207.57
|
| Rate for Payer: BCN Commercial |
$196.52
|
| Rate for Payer: Cash Price |
$202.78
|
| Rate for Payer: Cofinity Commercial |
$238.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.78
|
| Rate for Payer: Healthscope Commercial |
$253.47
|
| Rate for Payer: Healthscope Whirlpool |
$245.87
|
| Rate for Payer: Mclaren Commercial |
$228.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.45
|
| Rate for Payer: Nomi Health Commercial |
$207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.09
|
| Rate for Payer: Priority Health Narrow Network |
$177.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.05
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$52.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$47.20
|
| 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 |
$50.87
|
| Rate for Payer: ASR Commercial |
$50.87
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.94
|
| Rate for Payer: BCN Commercial |
$40.66
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$50.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$47.20
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| 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 |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.95
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.76
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
IP
|
$52.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$47.20
|
| Rate for Payer: ASR ASR |
$50.87
|
| Rate for Payer: ASR Commercial |
$50.87
|
| Rate for Payer: BCBS Trust/PPO |
$42.73
|
| Rate for Payer: BCN Commercial |
$40.66
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$50.87
|
| Rate for Payer: Mclaren Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.15
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Aetna Commercial |
$51.66
|
| Rate for Payer: ASR ASR |
$55.68
|
| Rate for Payer: ASR Commercial |
$55.68
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.50
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Healthscope Commercial |
$57.40
|
| Rate for Payer: Healthscope Whirlpool |
$55.68
|
| Rate for Payer: Mclaren Commercial |
$51.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.51
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Aetna Commercial |
$51.66
|
| 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 |
$55.68
|
| Rate for Payer: ASR Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$47.00
|
| Rate for Payer: BCN Commercial |
$44.50
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$57.40
|
| Rate for Payer: Healthscope Whirlpool |
$55.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$51.66
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| 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 |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.29
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$40.24
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$972.10
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$388.84 |
| Max. Negotiated Rate |
$972.10 |
| Rate for Payer: Aetna Commercial |
$874.89
|
| Rate for Payer: Aetna Medicare |
$486.05
|
| Rate for Payer: ASR ASR |
$942.94
|
| Rate for Payer: ASR Commercial |
$942.94
|
| Rate for Payer: BCBS Complete |
$388.84
|
| Rate for Payer: BCBS Trust/PPO |
$796.05
|
| Rate for Payer: BCN Commercial |
$753.67
|
| Rate for Payer: Cash Price |
$777.68
|
| Rate for Payer: Cofinity Commercial |
$913.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.68
|
| Rate for Payer: Healthscope Commercial |
$972.10
|
| Rate for Payer: Healthscope Whirlpool |
$942.94
|
| Rate for Payer: Mclaren Commercial |
$874.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.28
|
| Rate for Payer: Nomi Health Commercial |
$797.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.75
|
| Rate for Payer: Priority Health Narrow Network |
$681.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.45
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$972.10
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$631.87 |
| Max. Negotiated Rate |
$972.10 |
| Rate for Payer: Aetna Commercial |
$874.89
|
| Rate for Payer: ASR ASR |
$942.94
|
| Rate for Payer: ASR Commercial |
$942.94
|
| Rate for Payer: BCBS Trust/PPO |
$792.16
|
| Rate for Payer: BCN Commercial |
$753.67
|
| Rate for Payer: Cash Price |
$777.68
|
| Rate for Payer: Cofinity Commercial |
$913.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.68
|
| Rate for Payer: Healthscope Commercial |
$972.10
|
| Rate for Payer: Healthscope Whirlpool |
$942.94
|
| Rate for Payer: Mclaren Commercial |
$874.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.28
|
| Rate for Payer: Nomi Health Commercial |
$797.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.45
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$596.14
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$596.14 |
| Rate for Payer: Aetna Commercial |
$536.53
|
| Rate for Payer: ASR ASR |
$578.26
|
| Rate for Payer: ASR Commercial |
$578.26
|
| Rate for Payer: BCBS Trust/PPO |
$485.79
|
| Rate for Payer: BCN Commercial |
$462.19
|
| Rate for Payer: Cash Price |
$476.91
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$596.14
|
| Rate for Payer: Healthscope Whirlpool |
$578.26
|
| Rate for Payer: Mclaren Commercial |
$536.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.72
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$524.60
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$596.14
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$238.46 |
| Max. Negotiated Rate |
$596.14 |
| Rate for Payer: Aetna Commercial |
$536.53
|
| Rate for Payer: Aetna Medicare |
$298.07
|
| Rate for Payer: ASR ASR |
$578.26
|
| Rate for Payer: ASR Commercial |
$578.26
|
| Rate for Payer: BCBS Complete |
$238.46
|
| Rate for Payer: BCBS Trust/PPO |
$488.18
|
| Rate for Payer: BCN Commercial |
$462.19
|
| Rate for Payer: Cash Price |
$476.91
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$596.14
|
| Rate for Payer: Healthscope Whirlpool |
$578.26
|
| Rate for Payer: Mclaren Commercial |
$536.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.72
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.34
|
| Rate for Payer: Priority Health Narrow Network |
$417.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$524.60
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,466.73
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$586.69 |
| Max. Negotiated Rate |
$1,466.73 |
| Rate for Payer: Aetna Commercial |
$1,320.06
|
| Rate for Payer: Aetna Medicare |
$733.37
|
| Rate for Payer: ASR ASR |
$1,422.73
|
| Rate for Payer: ASR Commercial |
$1,422.73
|
| Rate for Payer: BCBS Complete |
$586.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.11
|
| Rate for Payer: BCN Commercial |
$1,137.16
|
| Rate for Payer: Cash Price |
$1,173.38
|
| Rate for Payer: Cofinity Commercial |
$1,378.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.38
|
| Rate for Payer: Healthscope Commercial |
$1,466.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,422.73
|
| Rate for Payer: Mclaren Commercial |
$1,320.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,246.72
|
| Rate for Payer: Nomi Health Commercial |
$1,202.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,285.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,290.72
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,466.73
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$953.37 |
| Max. Negotiated Rate |
$1,466.73 |
| Rate for Payer: Aetna Commercial |
$1,320.06
|
| Rate for Payer: ASR ASR |
$1,422.73
|
| Rate for Payer: ASR Commercial |
$1,422.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.24
|
| Rate for Payer: BCN Commercial |
$1,137.16
|
| Rate for Payer: Cash Price |
$1,173.38
|
| Rate for Payer: Cofinity Commercial |
$1,378.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.38
|
| Rate for Payer: Healthscope Commercial |
$1,466.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,422.73
|
| Rate for Payer: Mclaren Commercial |
$1,320.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,246.72
|
| Rate for Payer: Nomi Health Commercial |
$1,202.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,290.72
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$329.81
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$329.81 |
| Rate for Payer: Aetna Commercial |
$296.83
|
| Rate for Payer: ASR ASR |
$319.92
|
| Rate for Payer: ASR Commercial |
$319.92
|
| Rate for Payer: BCBS Trust/PPO |
$268.76
|
| Rate for Payer: BCN Commercial |
$255.70
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$310.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Healthscope Commercial |
$329.81
|
| Rate for Payer: Healthscope Whirlpool |
$319.92
|
| Rate for Payer: Mclaren Commercial |
$296.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.23
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$329.81
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.92 |
| Max. Negotiated Rate |
$329.81 |
| Rate for Payer: Aetna Commercial |
$296.83
|
| Rate for Payer: Aetna Medicare |
$164.91
|
| Rate for Payer: ASR ASR |
$319.92
|
| Rate for Payer: ASR Commercial |
$319.92
|
| Rate for Payer: BCBS Complete |
$131.92
|
| Rate for Payer: BCBS Trust/PPO |
$270.08
|
| Rate for Payer: BCN Commercial |
$255.70
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$310.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Healthscope Commercial |
$329.81
|
| Rate for Payer: Healthscope Whirlpool |
$319.92
|
| Rate for Payer: Mclaren Commercial |
$296.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.98
|
| Rate for Payer: Priority Health Narrow Network |
$231.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.23
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$132.50
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Aetna Commercial |
$119.25
|
| Rate for Payer: Aetna Medicare |
$66.25
|
| Rate for Payer: ASR ASR |
$128.53
|
| Rate for Payer: ASR Commercial |
$128.53
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$108.50
|
| Rate for Payer: BCN Commercial |
$102.73
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cofinity Commercial |
$124.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$132.50
|
| Rate for Payer: Healthscope Whirlpool |
$128.53
|
| Rate for Payer: Mclaren Commercial |
$119.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.62
|
| Rate for Payer: Nomi Health Commercial |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.10
|
| Rate for Payer: Priority Health Narrow Network |
$92.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.60
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$132.50
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Aetna Commercial |
$119.25
|
| Rate for Payer: ASR ASR |
$128.53
|
| Rate for Payer: ASR Commercial |
$128.53
|
| Rate for Payer: BCBS Trust/PPO |
$107.97
|
| Rate for Payer: BCN Commercial |
$102.73
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cofinity Commercial |
$124.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$132.50
|
| Rate for Payer: Healthscope Whirlpool |
$128.53
|
| Rate for Payer: Mclaren Commercial |
$119.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.62
|
| Rate for Payer: Nomi Health Commercial |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.60
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,497.14
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$1,497.14 |
| Rate for Payer: Aetna Commercial |
$1,347.43
|
| Rate for Payer: ASR ASR |
$1,452.23
|
| Rate for Payer: ASR Commercial |
$1,452.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.02
|
| Rate for Payer: BCN Commercial |
$1,160.73
|
| Rate for Payer: Cash Price |
$1,197.71
|
| Rate for Payer: Cofinity Commercial |
$1,407.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,197.71
|
| Rate for Payer: Healthscope Commercial |
$1,497.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,452.23
|
| Rate for Payer: Mclaren Commercial |
$1,347.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,272.57
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,317.48
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,497.14
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$598.86 |
| Max. Negotiated Rate |
$1,497.14 |
| Rate for Payer: Aetna Commercial |
$1,347.43
|
| Rate for Payer: Aetna Medicare |
$748.57
|
| Rate for Payer: ASR ASR |
$1,452.23
|
| Rate for Payer: ASR Commercial |
$1,452.23
|
| Rate for Payer: BCBS Complete |
$598.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.01
|
| Rate for Payer: BCN Commercial |
$1,160.73
|
| Rate for Payer: Cash Price |
$1,197.71
|
| Rate for Payer: Cofinity Commercial |
$1,407.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,197.71
|
| Rate for Payer: Healthscope Commercial |
$1,497.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,452.23
|
| Rate for Payer: Mclaren Commercial |
$1,347.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,272.57
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,317.48
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$147.44
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Aetna Commercial |
$132.70
|
| Rate for Payer: Aetna Medicare |
$73.72
|
| Rate for Payer: ASR ASR |
$143.02
|
| Rate for Payer: ASR Commercial |
$143.02
|
| Rate for Payer: BCBS Complete |
$58.98
|
| Rate for Payer: BCBS Trust/PPO |
$120.74
|
| Rate for Payer: BCN Commercial |
$114.31
|
| Rate for Payer: Cash Price |
$117.95
|
| Rate for Payer: Cofinity Commercial |
$138.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.95
|
| Rate for Payer: Healthscope Commercial |
$147.44
|
| Rate for Payer: Healthscope Whirlpool |
$143.02
|
| Rate for Payer: Mclaren Commercial |
$132.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: Nomi Health Commercial |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.19
|
| Rate for Payer: Priority Health Narrow Network |
$103.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.75
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$147.44
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Aetna Commercial |
$132.70
|
| Rate for Payer: ASR ASR |
$143.02
|
| Rate for Payer: ASR Commercial |
$143.02
|
| Rate for Payer: BCBS Trust/PPO |
$120.15
|
| Rate for Payer: BCN Commercial |
$114.31
|
| Rate for Payer: Cash Price |
$117.95
|
| Rate for Payer: Cofinity Commercial |
$138.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.95
|
| Rate for Payer: Healthscope Commercial |
$147.44
|
| Rate for Payer: Healthscope Whirlpool |
$143.02
|
| Rate for Payer: Mclaren Commercial |
$132.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: Nomi Health Commercial |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.75
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$222.17 |
| Max. Negotiated Rate |
$341.80 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: ASR ASR |
$331.55
|
| Rate for Payer: ASR Commercial |
$331.55
|
| Rate for Payer: BCBS Trust/PPO |
$278.53
|
| Rate for Payer: BCN Commercial |
$265.00
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$321.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Healthscope Commercial |
$341.80
|
| Rate for Payer: Healthscope Whirlpool |
$331.55
|
| Rate for Payer: Mclaren Commercial |
$307.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: Nomi Health Commercial |
$280.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.78
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.72 |
| Max. Negotiated Rate |
$341.80 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$170.90
|
| Rate for Payer: ASR ASR |
$331.55
|
| Rate for Payer: ASR Commercial |
$331.55
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS Trust/PPO |
$279.90
|
| Rate for Payer: BCN Commercial |
$265.00
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$321.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Healthscope Commercial |
$341.80
|
| Rate for Payer: Healthscope Whirlpool |
$331.55
|
| Rate for Payer: Mclaren Commercial |
$307.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: Nomi Health Commercial |
$280.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.49
|
| Rate for Payer: Priority Health Narrow Network |
$239.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.78
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: ASR Commercial |
$292.96
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$247.32
|
| Rate for Payer: BCN Commercial |
$234.16
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$283.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$302.02
|
| Rate for Payer: Healthscope Whirlpool |
$292.96
|
| Rate for Payer: Mclaren Commercial |
$271.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.63
|
| Rate for Payer: Priority Health Narrow Network |
$211.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
