|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.73 |
| Max. Negotiated Rate |
$422.66 |
| Rate for Payer: Aetna Commercial |
$380.39
|
| Rate for Payer: ASR ASR |
$409.98
|
| Rate for Payer: ASR Commercial |
$409.98
|
| Rate for Payer: BCBS Trust/PPO |
$344.43
|
| Rate for Payer: BCN Commercial |
$327.69
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$397.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$422.66
|
| Rate for Payer: Healthscope Whirlpool |
$409.98
|
| Rate for Payer: Mclaren Commercial |
$380.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: Nomi Health Commercial |
$346.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.94
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$422.66 |
| Rate for Payer: Aetna Commercial |
$380.39
|
| Rate for Payer: Aetna Medicare |
$211.33
|
| Rate for Payer: ASR ASR |
$409.98
|
| Rate for Payer: ASR Commercial |
$409.98
|
| Rate for Payer: BCBS Complete |
$169.06
|
| Rate for Payer: BCBS Trust/PPO |
$346.12
|
| Rate for Payer: BCN Commercial |
$327.69
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$397.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$422.66
|
| Rate for Payer: Healthscope Whirlpool |
$409.98
|
| Rate for Payer: Mclaren Commercial |
$380.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: Nomi Health Commercial |
$346.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.33
|
| Rate for Payer: Priority Health Narrow Network |
$296.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.94
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.67 |
| Max. Negotiated Rate |
$507.18 |
| Rate for Payer: Aetna Commercial |
$456.46
|
| Rate for Payer: ASR ASR |
$491.96
|
| Rate for Payer: ASR Commercial |
$491.96
|
| Rate for Payer: BCBS Trust/PPO |
$413.30
|
| Rate for Payer: BCN Commercial |
$393.22
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$476.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Healthscope Commercial |
$507.18
|
| Rate for Payer: Healthscope Whirlpool |
$491.96
|
| Rate for Payer: Mclaren Commercial |
$456.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: Nomi Health Commercial |
$415.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.32
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$507.18 |
| Rate for Payer: Aetna Commercial |
$456.46
|
| Rate for Payer: Aetna Medicare |
$253.59
|
| Rate for Payer: ASR ASR |
$491.96
|
| Rate for Payer: ASR Commercial |
$491.96
|
| Rate for Payer: BCBS Complete |
$202.87
|
| Rate for Payer: BCBS Trust/PPO |
$415.33
|
| Rate for Payer: BCN Commercial |
$393.22
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$476.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Healthscope Commercial |
$507.18
|
| Rate for Payer: Healthscope Whirlpool |
$491.96
|
| Rate for Payer: Mclaren Commercial |
$456.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: Nomi Health Commercial |
$415.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.39
|
| Rate for Payer: Priority Health Narrow Network |
$355.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.32
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$299.88 |
| Rate for Payer: Aetna Commercial |
$269.89
|
| Rate for Payer: ASR ASR |
$290.88
|
| Rate for Payer: ASR Commercial |
$290.88
|
| Rate for Payer: BCBS Trust/PPO |
$244.37
|
| Rate for Payer: BCN Commercial |
$232.50
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$281.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$299.88
|
| Rate for Payer: Healthscope Whirlpool |
$290.88
|
| Rate for Payer: Mclaren Commercial |
$269.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: Nomi Health Commercial |
$245.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.89
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.95 |
| Max. Negotiated Rate |
$299.88 |
| Rate for Payer: Aetna Commercial |
$269.89
|
| Rate for Payer: Aetna Medicare |
$149.94
|
| Rate for Payer: ASR ASR |
$290.88
|
| Rate for Payer: ASR Commercial |
$290.88
|
| Rate for Payer: BCBS Complete |
$119.95
|
| Rate for Payer: BCBS Trust/PPO |
$245.57
|
| Rate for Payer: BCN Commercial |
$232.50
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$281.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$299.88
|
| Rate for Payer: Healthscope Whirlpool |
$290.88
|
| Rate for Payer: Mclaren Commercial |
$269.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: Nomi Health Commercial |
$245.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.75
|
| Rate for Payer: Priority Health Narrow Network |
$210.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.89
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.58 |
| Max. Negotiated Rate |
$513.96 |
| Rate for Payer: Aetna Commercial |
$462.56
|
| Rate for Payer: Aetna Medicare |
$256.98
|
| Rate for Payer: ASR ASR |
$498.54
|
| Rate for Payer: ASR Commercial |
$498.54
|
| Rate for Payer: BCBS Complete |
$205.58
|
| Rate for Payer: BCBS Trust/PPO |
$420.88
|
| Rate for Payer: BCN Commercial |
$398.47
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$483.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$513.96
|
| Rate for Payer: Healthscope Whirlpool |
$498.54
|
| Rate for Payer: Mclaren Commercial |
$462.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: Nomi Health Commercial |
$421.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.33
|
| Rate for Payer: Priority Health Narrow Network |
$360.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$452.28
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$334.07 |
| Max. Negotiated Rate |
$513.96 |
| Rate for Payer: Aetna Commercial |
$462.56
|
| Rate for Payer: ASR ASR |
$498.54
|
| Rate for Payer: ASR Commercial |
$498.54
|
| Rate for Payer: BCBS Trust/PPO |
$418.83
|
| Rate for Payer: BCN Commercial |
$398.47
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$483.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$513.96
|
| Rate for Payer: Healthscope Whirlpool |
$498.54
|
| Rate for Payer: Mclaren Commercial |
$462.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: Nomi Health Commercial |
$421.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$452.28
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.32 |
| Max. Negotiated Rate |
$420.79 |
| Rate for Payer: Aetna Commercial |
$378.71
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: ASR ASR |
$408.17
|
| Rate for Payer: ASR Commercial |
$408.17
|
| Rate for Payer: BCBS Complete |
$168.32
|
| Rate for Payer: BCBS Trust/PPO |
$344.58
|
| Rate for Payer: BCN Commercial |
$326.24
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$395.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Healthscope Commercial |
$420.79
|
| Rate for Payer: Healthscope Whirlpool |
$408.17
|
| Rate for Payer: Mclaren Commercial |
$378.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: Nomi Health Commercial |
$345.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Narrow Network |
$294.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.30
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$273.51 |
| Max. Negotiated Rate |
$420.79 |
| Rate for Payer: Aetna Commercial |
$378.71
|
| Rate for Payer: ASR ASR |
$408.17
|
| Rate for Payer: ASR Commercial |
$408.17
|
| Rate for Payer: BCBS Trust/PPO |
$342.90
|
| Rate for Payer: BCN Commercial |
$326.24
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$395.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Healthscope Commercial |
$420.79
|
| Rate for Payer: Healthscope Whirlpool |
$408.17
|
| Rate for Payer: Mclaren Commercial |
$378.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: Nomi Health Commercial |
$345.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.30
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: ASR ASR |
$178.09
|
| Rate for Payer: ASR Commercial |
$178.09
|
| Rate for Payer: BCBS Trust/PPO |
$149.62
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Aetna Medicare |
$91.80
|
| Rate for Payer: ASR ASR |
$178.09
|
| Rate for Payer: ASR Commercial |
$178.09
|
| Rate for Payer: BCBS Complete |
$73.44
|
| Rate for Payer: BCBS Trust/PPO |
$150.35
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.87
|
| Rate for Payer: Priority Health Narrow Network |
$128.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: ASR ASR |
$123.67
|
| Rate for Payer: ASR Commercial |
$123.67
|
| Rate for Payer: BCBS Trust/PPO |
$103.90
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$127.50
|
| Rate for Payer: Healthscope Whirlpool |
$123.67
|
| Rate for Payer: Mclaren Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.20
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Medicare |
$63.75
|
| Rate for Payer: ASR ASR |
$123.67
|
| Rate for Payer: ASR Commercial |
$123.67
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$104.41
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$127.50
|
| Rate for Payer: Healthscope Whirlpool |
$123.67
|
| Rate for Payer: Mclaren Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.72
|
| Rate for Payer: Priority Health Narrow Network |
$89.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.20
|
|
|
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 HFO W/O JOINTS CF
|
Facility
|
IP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.71 |
| Max. Negotiated Rate |
$258.02 |
| Rate for Payer: Aetna Commercial |
$232.22
|
| Rate for Payer: ASR ASR |
$250.28
|
| Rate for Payer: ASR Commercial |
$250.28
|
| Rate for Payer: BCBS Trust/PPO |
$210.26
|
| 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: 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
|
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 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 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 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 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 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 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
|
|
