|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.21 |
| Max. Negotiated Rate |
$258.02 |
| Rate for Payer: Aetna Commercial |
$232.22
|
| Rate for Payer: Aetna Medicare |
$129.01
|
| Rate for Payer: ASR ASR |
$250.28
|
| Rate for Payer: ASR Commercial |
$250.28
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: BCBS Trust/PPO |
$211.29
|
| Rate for Payer: BCN Commercial |
$200.04
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$242.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$258.02
|
| Rate for Payer: Healthscope Whirlpool |
$250.28
|
| Rate for Payer: Mclaren Commercial |
$232.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.32
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.08
|
| Rate for Payer: Priority Health Narrow Network |
$180.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.06
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.99 |
| Max. Negotiated Rate |
$1,847.67 |
| Rate for Payer: Aetna Commercial |
$1,662.90
|
| Rate for Payer: ASR ASR |
$1,792.24
|
| Rate for Payer: ASR Commercial |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.67
|
| Rate for Payer: BCN Commercial |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,736.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Healthscope Commercial |
$1,847.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,662.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: Nomi Health Commercial |
$1,515.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,625.95
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.07 |
| Max. Negotiated Rate |
$1,847.67 |
| Rate for Payer: Aetna Commercial |
$1,662.90
|
| Rate for Payer: Aetna Medicare |
$923.84
|
| Rate for Payer: ASR ASR |
$1,792.24
|
| Rate for Payer: ASR Commercial |
$1,792.24
|
| Rate for Payer: BCBS Complete |
$739.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.06
|
| Rate for Payer: BCN Commercial |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,736.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Healthscope Commercial |
$1,847.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,662.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: Nomi Health Commercial |
$1,515.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,618.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,295.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,625.95
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$333.23 |
| Max. Negotiated Rate |
$833.07 |
| Rate for Payer: Aetna Commercial |
$749.76
|
| Rate for Payer: Aetna Medicare |
$416.54
|
| Rate for Payer: ASR ASR |
$808.08
|
| Rate for Payer: ASR Commercial |
$808.08
|
| Rate for Payer: BCBS Complete |
$333.23
|
| Rate for Payer: BCBS Trust/PPO |
$682.20
|
| Rate for Payer: BCN Commercial |
$645.88
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$783.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Healthscope Commercial |
$833.07
|
| Rate for Payer: Healthscope Whirlpool |
$808.08
|
| Rate for Payer: Mclaren Commercial |
$749.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: Nomi Health Commercial |
$683.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.94
|
| Rate for Payer: Priority Health Narrow Network |
$583.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$733.10
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$541.50 |
| Max. Negotiated Rate |
$833.07 |
| Rate for Payer: Aetna Commercial |
$749.76
|
| Rate for Payer: ASR ASR |
$808.08
|
| Rate for Payer: ASR Commercial |
$808.08
|
| Rate for Payer: BCBS Trust/PPO |
$678.87
|
| Rate for Payer: BCN Commercial |
$645.88
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$783.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Healthscope Commercial |
$833.07
|
| Rate for Payer: Healthscope Whirlpool |
$808.08
|
| Rate for Payer: Mclaren Commercial |
$749.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: Nomi Health Commercial |
$683.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$733.10
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.18 |
| Max. Negotiated Rate |
$957.96 |
| Rate for Payer: Aetna Commercial |
$862.16
|
| Rate for Payer: Aetna Medicare |
$478.98
|
| Rate for Payer: ASR ASR |
$929.22
|
| Rate for Payer: ASR Commercial |
$929.22
|
| Rate for Payer: BCBS Complete |
$383.18
|
| Rate for Payer: BCBS Trust/PPO |
$784.47
|
| Rate for Payer: BCN Commercial |
$742.71
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$900.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Healthscope Commercial |
$957.96
|
| Rate for Payer: Healthscope Whirlpool |
$929.22
|
| Rate for Payer: Mclaren Commercial |
$862.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: Nomi Health Commercial |
$785.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.36
|
| Rate for Payer: Priority Health Narrow Network |
$671.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.00
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$622.67 |
| Max. Negotiated Rate |
$957.96 |
| Rate for Payer: Aetna Commercial |
$862.16
|
| Rate for Payer: ASR ASR |
$929.22
|
| Rate for Payer: ASR Commercial |
$929.22
|
| Rate for Payer: BCBS Trust/PPO |
$780.64
|
| Rate for Payer: BCN Commercial |
$742.71
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$900.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Healthscope Commercial |
$957.96
|
| Rate for Payer: Healthscope Whirlpool |
$929.22
|
| Rate for Payer: Mclaren Commercial |
$862.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: Nomi Health Commercial |
$785.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.00
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,988.41 |
| Max. Negotiated Rate |
$4,971.02 |
| Rate for Payer: Aetna Commercial |
$4,473.92
|
| Rate for Payer: Aetna Medicare |
$2,485.51
|
| Rate for Payer: ASR ASR |
$4,821.89
|
| Rate for Payer: ASR Commercial |
$4,821.89
|
| Rate for Payer: BCBS Complete |
$1,988.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,070.77
|
| Rate for Payer: BCN Commercial |
$3,854.03
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$4,672.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,971.02
|
| Rate for Payer: Healthscope Whirlpool |
$4,821.89
|
| Rate for Payer: Mclaren Commercial |
$4,473.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: Nomi Health Commercial |
$4,076.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,355.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,484.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,374.50
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,231.16 |
| Max. Negotiated Rate |
$4,971.02 |
| Rate for Payer: Aetna Commercial |
$4,473.92
|
| Rate for Payer: ASR ASR |
$4,821.89
|
| Rate for Payer: ASR Commercial |
$4,821.89
|
| Rate for Payer: BCBS Trust/PPO |
$4,050.88
|
| Rate for Payer: BCN Commercial |
$3,854.03
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$4,672.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,971.02
|
| Rate for Payer: Healthscope Whirlpool |
$4,821.89
|
| Rate for Payer: Mclaren Commercial |
$4,473.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: Nomi Health Commercial |
$4,076.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,374.50
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$554.15 |
| Max. Negotiated Rate |
$1,385.37 |
| Rate for Payer: Aetna Commercial |
$1,246.83
|
| Rate for Payer: Aetna Medicare |
$692.68
|
| Rate for Payer: ASR ASR |
$1,343.81
|
| Rate for Payer: ASR Commercial |
$1,343.81
|
| Rate for Payer: BCBS Complete |
$554.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.48
|
| Rate for Payer: BCN Commercial |
$1,074.08
|
| Rate for Payer: Cash Price |
$1,108.30
|
| Rate for Payer: Cofinity Commercial |
$1,302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.30
|
| Rate for Payer: Healthscope Commercial |
$1,385.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.81
|
| Rate for Payer: Mclaren Commercial |
$1,246.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.56
|
| Rate for Payer: Nomi Health Commercial |
$1,136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,213.86
|
| Rate for Payer: Priority Health Narrow Network |
$971.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.13
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.49 |
| Max. Negotiated Rate |
$1,385.37 |
| Rate for Payer: Aetna Commercial |
$1,246.83
|
| Rate for Payer: ASR ASR |
$1,343.81
|
| Rate for Payer: ASR Commercial |
$1,343.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.94
|
| Rate for Payer: BCN Commercial |
$1,074.08
|
| Rate for Payer: Cash Price |
$1,108.30
|
| Rate for Payer: Cofinity Commercial |
$1,302.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.30
|
| Rate for Payer: Healthscope Commercial |
$1,385.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.81
|
| Rate for Payer: Mclaren Commercial |
$1,246.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.56
|
| Rate for Payer: Nomi Health Commercial |
$1,136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.13
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,059.41 |
| Max. Negotiated Rate |
$1,629.86 |
| Rate for Payer: Aetna Commercial |
$1,466.87
|
| Rate for Payer: ASR ASR |
$1,580.96
|
| Rate for Payer: ASR Commercial |
$1,580.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.17
|
| Rate for Payer: BCN Commercial |
$1,263.63
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,532.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Healthscope Commercial |
$1,629.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.96
|
| Rate for Payer: Mclaren Commercial |
$1,466.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: Nomi Health Commercial |
$1,336.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,434.28
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.94 |
| Max. Negotiated Rate |
$1,629.86 |
| Rate for Payer: Aetna Commercial |
$1,466.87
|
| Rate for Payer: Aetna Medicare |
$814.93
|
| Rate for Payer: ASR ASR |
$1,580.96
|
| Rate for Payer: ASR Commercial |
$1,580.96
|
| Rate for Payer: BCBS Complete |
$651.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.69
|
| Rate for Payer: BCN Commercial |
$1,263.63
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,532.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Healthscope Commercial |
$1,629.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,580.96
|
| Rate for Payer: Mclaren Commercial |
$1,466.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: Nomi Health Commercial |
$1,336.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,428.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,434.28
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$202.83 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: ASR ASR |
$196.75
|
| Rate for Payer: ASR Commercial |
$196.75
|
| Rate for Payer: BCBS Trust/PPO |
$165.29
|
| Rate for Payer: BCN Commercial |
$157.25
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$202.83
|
| Rate for Payer: Healthscope Whirlpool |
$196.75
|
| Rate for Payer: Mclaren Commercial |
$182.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: Nomi Health Commercial |
$166.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.49
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.13 |
| Max. Negotiated Rate |
$202.83 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: Aetna Medicare |
$101.42
|
| Rate for Payer: ASR ASR |
$196.75
|
| Rate for Payer: ASR Commercial |
$196.75
|
| Rate for Payer: BCBS Complete |
$81.13
|
| Rate for Payer: BCBS Trust/PPO |
$166.10
|
| Rate for Payer: BCN Commercial |
$157.25
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$202.83
|
| Rate for Payer: Healthscope Whirlpool |
$196.75
|
| Rate for Payer: Mclaren Commercial |
$182.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: Nomi Health Commercial |
$166.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.72
|
| Rate for Payer: Priority Health Narrow Network |
$142.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.49
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.66 |
| Max. Negotiated Rate |
$651.78 |
| Rate for Payer: Aetna Commercial |
$586.60
|
| Rate for Payer: ASR ASR |
$632.23
|
| Rate for Payer: ASR Commercial |
$632.23
|
| Rate for Payer: BCBS Trust/PPO |
$531.14
|
| Rate for Payer: BCN Commercial |
$505.33
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Healthscope Commercial |
$651.78
|
| Rate for Payer: Healthscope Whirlpool |
$632.23
|
| Rate for Payer: Mclaren Commercial |
$586.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: Nomi Health Commercial |
$534.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.57
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$651.78 |
| Rate for Payer: Aetna Commercial |
$586.60
|
| Rate for Payer: Aetna Medicare |
$325.89
|
| Rate for Payer: ASR ASR |
$632.23
|
| Rate for Payer: ASR Commercial |
$632.23
|
| Rate for Payer: BCBS Complete |
$260.71
|
| Rate for Payer: BCBS Trust/PPO |
$533.74
|
| Rate for Payer: BCN Commercial |
$505.33
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Healthscope Commercial |
$651.78
|
| Rate for Payer: Healthscope Whirlpool |
$632.23
|
| Rate for Payer: Mclaren Commercial |
$586.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: Nomi Health Commercial |
$534.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.09
|
| Rate for Payer: Priority Health Narrow Network |
$456.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$573.57
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| Rate for Payer: ASR ASR |
$180.07
|
| Rate for Payer: ASR Commercial |
$180.07
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$152.02
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$174.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$185.64
|
| Rate for Payer: Healthscope Whirlpool |
$180.07
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.66
|
| Rate for Payer: Priority Health Narrow Network |
$130.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.36
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: ASR ASR |
$180.07
|
| Rate for Payer: ASR Commercial |
$180.07
|
| Rate for Payer: BCBS Trust/PPO |
$151.28
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$174.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$185.64
|
| Rate for Payer: Healthscope Whirlpool |
$180.07
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.36
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$194.92 |
| Rate for Payer: Aetna Commercial |
$175.43
|
| Rate for Payer: Aetna Medicare |
$97.46
|
| Rate for Payer: ASR ASR |
$189.07
|
| Rate for Payer: ASR Commercial |
$189.07
|
| Rate for Payer: BCBS Complete |
$77.97
|
| Rate for Payer: BCBS Trust/PPO |
$159.62
|
| Rate for Payer: BCN Commercial |
$151.12
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$183.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Healthscope Commercial |
$194.92
|
| Rate for Payer: Healthscope Whirlpool |
$189.07
|
| Rate for Payer: Mclaren Commercial |
$175.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: Nomi Health Commercial |
$159.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.79
|
| Rate for Payer: Priority Health Narrow Network |
$136.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.53
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$194.92 |
| Rate for Payer: Aetna Commercial |
$175.43
|
| Rate for Payer: ASR ASR |
$189.07
|
| Rate for Payer: ASR Commercial |
$189.07
|
| Rate for Payer: BCBS Trust/PPO |
$158.84
|
| Rate for Payer: BCN Commercial |
$151.12
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$183.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Healthscope Commercial |
$194.92
|
| Rate for Payer: Healthscope Whirlpool |
$189.07
|
| Rate for Payer: Mclaren Commercial |
$175.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: Nomi Health Commercial |
$159.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.53
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,660.43 |
| Max. Negotiated Rate |
$2,554.51 |
| Rate for Payer: Aetna Commercial |
$2,299.06
|
| Rate for Payer: ASR ASR |
$2,477.87
|
| Rate for Payer: ASR Commercial |
$2,477.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.67
|
| Rate for Payer: BCN Commercial |
$1,980.51
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$2,401.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Healthscope Commercial |
$2,554.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,477.87
|
| Rate for Payer: Mclaren Commercial |
$2,299.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: Nomi Health Commercial |
$2,094.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,247.97
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,021.80 |
| Max. Negotiated Rate |
$2,554.51 |
| Rate for Payer: Aetna Commercial |
$2,299.06
|
| Rate for Payer: Aetna Medicare |
$1,277.26
|
| Rate for Payer: ASR ASR |
$2,477.87
|
| Rate for Payer: ASR Commercial |
$2,477.87
|
| Rate for Payer: BCBS Complete |
$1,021.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,091.89
|
| Rate for Payer: BCN Commercial |
$1,980.51
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$2,401.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Healthscope Commercial |
$2,554.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,477.87
|
| Rate for Payer: Mclaren Commercial |
$2,299.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: Nomi Health Commercial |
$2,094.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,238.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,790.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,247.97
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,767.53 |
| Max. Negotiated Rate |
$2,719.28 |
| Rate for Payer: Aetna Commercial |
$2,447.35
|
| Rate for Payer: ASR ASR |
$2,637.70
|
| Rate for Payer: ASR Commercial |
$2,637.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,215.94
|
| Rate for Payer: BCN Commercial |
$2,108.26
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$2,556.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Commercial |
$2,719.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,637.70
|
| Rate for Payer: Mclaren Commercial |
$2,447.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: Nomi Health Commercial |
$2,229.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,392.97
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,087.71 |
| Max. Negotiated Rate |
$2,719.28 |
| Rate for Payer: Aetna Commercial |
$2,447.35
|
| Rate for Payer: Aetna Medicare |
$1,359.64
|
| Rate for Payer: ASR ASR |
$2,637.70
|
| Rate for Payer: ASR Commercial |
$2,637.70
|
| Rate for Payer: BCBS Complete |
$1,087.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.82
|
| Rate for Payer: BCN Commercial |
$2,108.26
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$2,556.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Commercial |
$2,719.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,637.70
|
| Rate for Payer: Mclaren Commercial |
$2,447.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: Nomi Health Commercial |
$2,229.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,382.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,392.97
|
|
