|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$302.02 |
| Rate for Payer: Aetna Commercial |
$271.82
|
| Rate for Payer: ASR ASR |
$292.96
|
| Rate for Payer: ASR Commercial |
$292.96
|
| Rate for Payer: BCBS Trust/PPO |
$246.12
|
| 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: UHC All Payor (Choice/PPO) + Core |
$265.78
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: Aetna Medicare |
$48.02
|
| Rate for Payer: ASR ASR |
$93.17
|
| Rate for Payer: ASR Commercial |
$93.17
|
| Rate for Payer: BCBS Complete |
$38.42
|
| Rate for Payer: BCBS Trust/PPO |
$78.66
|
| Rate for Payer: BCN Commercial |
$74.47
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$96.05
|
| Rate for Payer: Healthscope Whirlpool |
$93.17
|
| Rate for Payer: Mclaren Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: Nomi Health Commercial |
$78.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.16
|
| Rate for Payer: Priority Health Narrow Network |
$67.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.52
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.43 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Aetna Commercial |
$86.44
|
| Rate for Payer: ASR ASR |
$93.17
|
| Rate for Payer: ASR Commercial |
$93.17
|
| Rate for Payer: BCBS Trust/PPO |
$78.27
|
| Rate for Payer: BCN Commercial |
$74.47
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$96.05
|
| Rate for Payer: Healthscope Whirlpool |
$93.17
|
| Rate for Payer: Mclaren Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: Nomi Health Commercial |
$78.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.52
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$448.51 |
| Max. Negotiated Rate |
$1,121.27 |
| Rate for Payer: Aetna Commercial |
$1,009.14
|
| Rate for Payer: Aetna Medicare |
$560.63
|
| Rate for Payer: ASR ASR |
$1,087.63
|
| Rate for Payer: ASR Commercial |
$1,087.63
|
| Rate for Payer: BCBS Complete |
$448.51
|
| Rate for Payer: BCBS Trust/PPO |
$918.21
|
| Rate for Payer: BCN Commercial |
$869.32
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$1,053.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Healthscope Commercial |
$1,121.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.63
|
| Rate for Payer: Mclaren Commercial |
$1,009.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: Nomi Health Commercial |
$919.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.46
|
| Rate for Payer: Priority Health Narrow Network |
$786.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$986.72
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.83 |
| Max. Negotiated Rate |
$1,121.27 |
| Rate for Payer: Aetna Commercial |
$1,009.14
|
| Rate for Payer: ASR ASR |
$1,087.63
|
| Rate for Payer: ASR Commercial |
$1,087.63
|
| Rate for Payer: BCBS Trust/PPO |
$913.72
|
| Rate for Payer: BCN Commercial |
$869.32
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$1,053.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Healthscope Commercial |
$1,121.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.63
|
| Rate for Payer: Mclaren Commercial |
$1,009.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: Nomi Health Commercial |
$919.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$986.72
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$818.36 |
| Max. Negotiated Rate |
$1,259.02 |
| Rate for Payer: Aetna Commercial |
$1,133.12
|
| Rate for Payer: ASR ASR |
$1,221.25
|
| Rate for Payer: ASR Commercial |
$1,221.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.98
|
| Rate for Payer: BCN Commercial |
$976.12
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Healthscope Commercial |
$1,259.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.25
|
| Rate for Payer: Mclaren Commercial |
$1,133.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: Nomi Health Commercial |
$1,032.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,107.94
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$503.61 |
| Max. Negotiated Rate |
$1,259.02 |
| Rate for Payer: Aetna Commercial |
$1,133.12
|
| Rate for Payer: Aetna Medicare |
$629.51
|
| Rate for Payer: ASR ASR |
$1,221.25
|
| Rate for Payer: ASR Commercial |
$1,221.25
|
| Rate for Payer: BCBS Complete |
$503.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.01
|
| Rate for Payer: BCN Commercial |
$976.12
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Healthscope Commercial |
$1,259.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.25
|
| Rate for Payer: Mclaren Commercial |
$1,133.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: Nomi Health Commercial |
$1,032.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,103.15
|
| Rate for Payer: Priority Health Narrow Network |
$882.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,107.94
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$696.15 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: ASR Commercial |
$1,038.87
|
| Rate for Payer: BCBS Trust/PPO |
$872.76
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna Medicare |
$535.50
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: ASR Commercial |
$1,038.87
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$877.04
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.41
|
| Rate for Payer: Priority Health Narrow Network |
$750.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,353.09 |
| Max. Negotiated Rate |
$5,882.73 |
| Rate for Payer: Aetna Commercial |
$5,294.46
|
| Rate for Payer: Aetna Medicare |
$2,941.36
|
| Rate for Payer: ASR ASR |
$5,706.25
|
| Rate for Payer: ASR Commercial |
$5,706.25
|
| Rate for Payer: BCBS Complete |
$2,353.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,817.37
|
| Rate for Payer: BCN Commercial |
$4,560.88
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Cofinity Commercial |
$5,529.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Healthscope Commercial |
$5,882.73
|
| Rate for Payer: Healthscope Whirlpool |
$5,706.25
|
| Rate for Payer: Mclaren Commercial |
$5,294.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: Nomi Health Commercial |
$4,823.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,154.45
|
| Rate for Payer: Priority Health Narrow Network |
$4,123.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,176.80
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,823.77 |
| Max. Negotiated Rate |
$5,882.73 |
| Rate for Payer: Aetna Commercial |
$5,294.46
|
| Rate for Payer: ASR ASR |
$5,706.25
|
| Rate for Payer: ASR Commercial |
$5,706.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,793.84
|
| Rate for Payer: BCN Commercial |
$4,560.88
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Cofinity Commercial |
$5,529.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Healthscope Commercial |
$5,882.73
|
| Rate for Payer: Healthscope Whirlpool |
$5,706.25
|
| Rate for Payer: Mclaren Commercial |
$5,294.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: Nomi Health Commercial |
$4,823.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,176.80
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.82 |
| Max. Negotiated Rate |
$1,482.06 |
| Rate for Payer: Aetna Commercial |
$1,333.85
|
| Rate for Payer: Aetna Medicare |
$741.03
|
| Rate for Payer: ASR ASR |
$1,437.60
|
| Rate for Payer: ASR Commercial |
$1,437.60
|
| Rate for Payer: BCBS Complete |
$592.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.66
|
| Rate for Payer: BCN Commercial |
$1,149.04
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,393.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Healthscope Commercial |
$1,482.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.60
|
| Rate for Payer: Mclaren Commercial |
$1,333.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: Nomi Health Commercial |
$1,215.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,298.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.21
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$963.34 |
| Max. Negotiated Rate |
$1,482.06 |
| Rate for Payer: Aetna Commercial |
$1,333.85
|
| Rate for Payer: ASR ASR |
$1,437.60
|
| Rate for Payer: ASR Commercial |
$1,437.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.73
|
| Rate for Payer: BCN Commercial |
$1,149.04
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,393.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Healthscope Commercial |
$1,482.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,437.60
|
| Rate for Payer: Mclaren Commercial |
$1,333.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: Nomi Health Commercial |
$1,215.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,304.21
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$247.86
|
| Rate for Payer: Aetna Medicare |
$137.70
|
| Rate for Payer: ASR ASR |
$267.14
|
| Rate for Payer: ASR Commercial |
$267.14
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: BCBS Trust/PPO |
$225.53
|
| Rate for Payer: BCN Commercial |
$213.52
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$258.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Healthscope Whirlpool |
$267.14
|
| Rate for Payer: Mclaren Commercial |
$247.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.31
|
| Rate for Payer: Priority Health Narrow Network |
$193.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.35
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$247.86
|
| Rate for Payer: ASR ASR |
$267.14
|
| Rate for Payer: ASR Commercial |
$267.14
|
| Rate for Payer: BCBS Trust/PPO |
$224.42
|
| Rate for Payer: BCN Commercial |
$213.52
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$258.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Healthscope Whirlpool |
$267.14
|
| Rate for Payer: Mclaren Commercial |
$247.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.35
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: Aetna Medicare |
$35.19
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: ASR Commercial |
$68.27
|
| Rate for Payer: BCBS Complete |
$28.15
|
| Rate for Payer: BCBS Trust/PPO |
$57.63
|
| Rate for Payer: BCN Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Healthscope Whirlpool |
$68.27
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.67
|
| Rate for Payer: Priority Health Narrow Network |
$49.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$63.34
|
| Rate for Payer: ASR ASR |
$68.27
|
| Rate for Payer: ASR Commercial |
$68.27
|
| Rate for Payer: BCBS Trust/PPO |
$57.35
|
| Rate for Payer: BCN Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$66.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Healthscope Whirlpool |
$68.27
|
| Rate for Payer: Mclaren Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.93
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$700.02 |
| Max. Negotiated Rate |
$1,076.95 |
| Rate for Payer: Aetna Commercial |
$969.25
|
| Rate for Payer: ASR ASR |
$1,044.64
|
| Rate for Payer: ASR Commercial |
$1,044.64
|
| Rate for Payer: BCBS Trust/PPO |
$877.61
|
| Rate for Payer: BCN Commercial |
$834.96
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$1,012.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Healthscope Commercial |
$1,076.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.64
|
| Rate for Payer: Mclaren Commercial |
$969.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: Nomi Health Commercial |
$883.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$947.72
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$430.78 |
| Max. Negotiated Rate |
$1,076.95 |
| Rate for Payer: Aetna Commercial |
$969.25
|
| Rate for Payer: Aetna Medicare |
$538.48
|
| Rate for Payer: ASR ASR |
$1,044.64
|
| Rate for Payer: ASR Commercial |
$1,044.64
|
| Rate for Payer: BCBS Complete |
$430.78
|
| Rate for Payer: BCBS Trust/PPO |
$881.91
|
| Rate for Payer: BCN Commercial |
$834.96
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$1,012.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Healthscope Commercial |
$1,076.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.64
|
| Rate for Payer: Mclaren Commercial |
$969.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: Nomi Health Commercial |
$883.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$943.62
|
| Rate for Payer: Priority Health Narrow Network |
$754.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$947.72
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.15 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: Aetna Commercial |
$628.83
|
| Rate for Payer: ASR ASR |
$677.74
|
| Rate for Payer: ASR Commercial |
$677.74
|
| Rate for Payer: BCBS Trust/PPO |
$569.37
|
| Rate for Payer: BCN Commercial |
$541.70
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$656.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Healthscope Commercial |
$698.70
|
| Rate for Payer: Healthscope Whirlpool |
$677.74
|
| Rate for Payer: Mclaren Commercial |
$628.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.89
|
| Rate for Payer: Nomi Health Commercial |
$572.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.86
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$279.48 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: Aetna Commercial |
$628.83
|
| Rate for Payer: Aetna Medicare |
$349.35
|
| Rate for Payer: ASR ASR |
$677.74
|
| Rate for Payer: ASR Commercial |
$677.74
|
| Rate for Payer: BCBS Complete |
$279.48
|
| Rate for Payer: BCBS Trust/PPO |
$572.17
|
| Rate for Payer: BCN Commercial |
$541.70
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$656.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Healthscope Commercial |
$698.70
|
| Rate for Payer: Healthscope Whirlpool |
$677.74
|
| Rate for Payer: Mclaren Commercial |
$628.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.89
|
| Rate for Payer: Nomi Health Commercial |
$572.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.20
|
| Rate for Payer: Priority Health Narrow Network |
$489.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.86
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$199.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$199.92 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: ASR ASR |
$193.92
|
| Rate for Payer: ASR Commercial |
$193.92
|
| Rate for Payer: BCBS Trust/PPO |
$162.91
|
| Rate for Payer: BCN Commercial |
$155.00
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$187.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$199.92
|
| Rate for Payer: Healthscope Whirlpool |
$193.92
|
| Rate for Payer: Mclaren Commercial |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.93
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$199.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$199.92 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: Aetna Medicare |
$99.96
|
| Rate for Payer: ASR ASR |
$193.92
|
| Rate for Payer: ASR Commercial |
$193.92
|
| Rate for Payer: BCBS Complete |
$79.97
|
| Rate for Payer: BCBS Trust/PPO |
$163.71
|
| Rate for Payer: BCN Commercial |
$155.00
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$187.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$199.92
|
| Rate for Payer: Healthscope Whirlpool |
$193.92
|
| Rate for Payer: Mclaren Commercial |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.17
|
| Rate for Payer: Priority Health Narrow Network |
$140.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.93
|
|
