|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$371.81 |
| Rate for Payer: Aetna Commercial |
$334.63
|
| Rate for Payer: ASR ASR |
$360.66
|
| Rate for Payer: ASR Commercial |
$360.66
|
| Rate for Payer: BCBS Trust/PPO |
$302.99
|
| Rate for Payer: BCN Commercial |
$288.26
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Healthscope Commercial |
$371.81
|
| Rate for Payer: Healthscope Whirlpool |
$360.66
|
| Rate for Payer: Mclaren Commercial |
$334.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: Nomi Health Commercial |
$304.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.19
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.72 |
| Max. Negotiated Rate |
$371.81 |
| Rate for Payer: Aetna Commercial |
$334.63
|
| Rate for Payer: Aetna Medicare |
$185.90
|
| Rate for Payer: ASR ASR |
$360.66
|
| Rate for Payer: ASR Commercial |
$360.66
|
| Rate for Payer: BCBS Complete |
$148.72
|
| Rate for Payer: BCBS Trust/PPO |
$304.48
|
| Rate for Payer: BCN Commercial |
$288.26
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Healthscope Commercial |
$371.81
|
| Rate for Payer: Healthscope Whirlpool |
$360.66
|
| Rate for Payer: Mclaren Commercial |
$334.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: Nomi Health Commercial |
$304.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.78
|
| Rate for Payer: Priority Health Narrow Network |
$260.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.19
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.11 |
| Max. Negotiated Rate |
$397.09 |
| Rate for Payer: Aetna Commercial |
$357.38
|
| Rate for Payer: ASR ASR |
$385.18
|
| Rate for Payer: ASR Commercial |
$385.18
|
| Rate for Payer: BCBS Trust/PPO |
$323.59
|
| Rate for Payer: BCN Commercial |
$307.86
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$373.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$397.09
|
| Rate for Payer: Healthscope Whirlpool |
$385.18
|
| Rate for Payer: Mclaren Commercial |
$357.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: Nomi Health Commercial |
$325.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.44
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.84 |
| Max. Negotiated Rate |
$397.09 |
| Rate for Payer: Aetna Commercial |
$357.38
|
| Rate for Payer: Aetna Medicare |
$198.54
|
| Rate for Payer: ASR ASR |
$385.18
|
| Rate for Payer: ASR Commercial |
$385.18
|
| Rate for Payer: BCBS Complete |
$158.84
|
| Rate for Payer: BCBS Trust/PPO |
$325.18
|
| Rate for Payer: BCN Commercial |
$307.86
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$373.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$397.09
|
| Rate for Payer: Healthscope Whirlpool |
$385.18
|
| Rate for Payer: Mclaren Commercial |
$357.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: Nomi Health Commercial |
$325.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.93
|
| Rate for Payer: Priority Health Narrow Network |
$278.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.44
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$283.91 |
| Max. Negotiated Rate |
$436.79 |
| Rate for Payer: Aetna Commercial |
$393.11
|
| Rate for Payer: ASR ASR |
$423.69
|
| Rate for Payer: ASR Commercial |
$423.69
|
| Rate for Payer: BCBS Trust/PPO |
$355.94
|
| Rate for Payer: BCN Commercial |
$338.64
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$410.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Healthscope Commercial |
$436.79
|
| Rate for Payer: Healthscope Whirlpool |
$423.69
|
| Rate for Payer: Mclaren Commercial |
$393.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: Nomi Health Commercial |
$358.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.38
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$436.79 |
| Rate for Payer: Aetna Commercial |
$393.11
|
| Rate for Payer: Aetna Medicare |
$218.40
|
| Rate for Payer: ASR ASR |
$423.69
|
| Rate for Payer: ASR Commercial |
$423.69
|
| Rate for Payer: BCBS Complete |
$174.72
|
| Rate for Payer: BCBS Trust/PPO |
$357.69
|
| Rate for Payer: BCN Commercial |
$338.64
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$410.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Healthscope Commercial |
$436.79
|
| Rate for Payer: Healthscope Whirlpool |
$423.69
|
| Rate for Payer: Mclaren Commercial |
$393.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: Nomi Health Commercial |
$358.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.72
|
| Rate for Payer: Priority Health Narrow Network |
$306.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.38
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.38 |
| Max. Negotiated Rate |
$538.45 |
| Rate for Payer: Aetna Commercial |
$484.60
|
| Rate for Payer: Aetna Medicare |
$269.22
|
| Rate for Payer: ASR ASR |
$522.30
|
| Rate for Payer: ASR Commercial |
$522.30
|
| Rate for Payer: BCBS Complete |
$215.38
|
| Rate for Payer: BCBS Trust/PPO |
$440.94
|
| Rate for Payer: BCN Commercial |
$417.46
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$506.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Healthscope Commercial |
$538.45
|
| Rate for Payer: Healthscope Whirlpool |
$522.30
|
| Rate for Payer: Mclaren Commercial |
$484.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: Nomi Health Commercial |
$441.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.79
|
| Rate for Payer: Priority Health Narrow Network |
$377.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.84
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.99 |
| Max. Negotiated Rate |
$538.45 |
| Rate for Payer: Aetna Commercial |
$484.60
|
| Rate for Payer: ASR ASR |
$522.30
|
| Rate for Payer: ASR Commercial |
$522.30
|
| Rate for Payer: BCBS Trust/PPO |
$438.78
|
| Rate for Payer: BCN Commercial |
$417.46
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$506.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Healthscope Commercial |
$538.45
|
| Rate for Payer: Healthscope Whirlpool |
$522.30
|
| Rate for Payer: Mclaren Commercial |
$484.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: Nomi Health Commercial |
$441.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.84
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$185.06 |
| Rate for Payer: Aetna Commercial |
$166.55
|
| Rate for Payer: Aetna Medicare |
$92.53
|
| Rate for Payer: ASR ASR |
$179.51
|
| Rate for Payer: ASR Commercial |
$179.51
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$143.48
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$173.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$185.06
|
| Rate for Payer: Healthscope Whirlpool |
$179.51
|
| Rate for Payer: Mclaren Commercial |
$166.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.15
|
| Rate for Payer: Priority Health Narrow Network |
$129.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.85
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.29 |
| Max. Negotiated Rate |
$185.06 |
| Rate for Payer: Aetna Commercial |
$166.55
|
| Rate for Payer: ASR ASR |
$179.51
|
| Rate for Payer: ASR Commercial |
$179.51
|
| Rate for Payer: BCBS Trust/PPO |
$150.81
|
| Rate for Payer: BCN Commercial |
$143.48
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$173.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$185.06
|
| Rate for Payer: Healthscope Whirlpool |
$179.51
|
| Rate for Payer: Mclaren Commercial |
$166.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.85
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$484.10
|
| Rate for Payer: ASR ASR |
$521.75
|
| Rate for Payer: ASR Commercial |
$521.75
|
| Rate for Payer: BCBS Trust/PPO |
$438.33
|
| Rate for Payer: BCN Commercial |
$417.03
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$505.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Healthscope Commercial |
$537.89
|
| Rate for Payer: Healthscope Whirlpool |
$521.75
|
| Rate for Payer: Mclaren Commercial |
$484.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: Nomi Health Commercial |
$441.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.34
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.16 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$484.10
|
| Rate for Payer: Aetna Medicare |
$268.94
|
| Rate for Payer: ASR ASR |
$521.75
|
| Rate for Payer: ASR Commercial |
$521.75
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS Trust/PPO |
$440.48
|
| Rate for Payer: BCN Commercial |
$417.03
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$505.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Healthscope Commercial |
$537.89
|
| Rate for Payer: Healthscope Whirlpool |
$521.75
|
| Rate for Payer: Mclaren Commercial |
$484.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: Nomi Health Commercial |
$441.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.30
|
| Rate for Payer: Priority Health Narrow Network |
$377.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.34
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Medicare |
$30.33
|
| Rate for Payer: ASR ASR |
$58.84
|
| Rate for Payer: ASR Commercial |
$58.84
|
| Rate for Payer: BCBS Complete |
$24.26
|
| Rate for Payer: BCBS Trust/PPO |
$49.67
|
| Rate for Payer: BCN Commercial |
$47.03
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$60.66
|
| Rate for Payer: Healthscope Whirlpool |
$58.84
|
| Rate for Payer: Mclaren Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: Nomi Health Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.15
|
| Rate for Payer: Priority Health Narrow Network |
$42.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.38
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.43 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: ASR ASR |
$58.84
|
| Rate for Payer: ASR Commercial |
$58.84
|
| Rate for Payer: BCBS Trust/PPO |
$49.43
|
| Rate for Payer: BCN Commercial |
$47.03
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$60.66
|
| Rate for Payer: Healthscope Whirlpool |
$58.84
|
| Rate for Payer: Mclaren Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: Nomi Health Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.38
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.18 |
| Max. Negotiated Rate |
$315.66 |
| Rate for Payer: Aetna Commercial |
$284.09
|
| Rate for Payer: ASR ASR |
$306.19
|
| Rate for Payer: ASR Commercial |
$306.19
|
| Rate for Payer: BCBS Trust/PPO |
$257.23
|
| Rate for Payer: BCN Commercial |
$244.73
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$296.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Healthscope Commercial |
$315.66
|
| Rate for Payer: Healthscope Whirlpool |
$306.19
|
| Rate for Payer: Mclaren Commercial |
$284.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: Nomi Health Commercial |
$258.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.78
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$315.66 |
| Rate for Payer: Aetna Commercial |
$284.09
|
| Rate for Payer: Aetna Medicare |
$157.83
|
| Rate for Payer: ASR ASR |
$306.19
|
| Rate for Payer: ASR Commercial |
$306.19
|
| Rate for Payer: BCBS Complete |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$258.49
|
| Rate for Payer: BCN Commercial |
$244.73
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$296.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Healthscope Commercial |
$315.66
|
| Rate for Payer: Healthscope Whirlpool |
$306.19
|
| Rate for Payer: Mclaren Commercial |
$284.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: Nomi Health Commercial |
$258.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.58
|
| Rate for Payer: Priority Health Narrow Network |
$221.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.78
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Trust/PPO |
$128.02
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$141.39
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: ASR ASR |
$152.39
|
| Rate for Payer: ASR Commercial |
$152.39
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.65
|
| Rate for Payer: BCN Commercial |
$121.80
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$157.10
|
| Rate for Payer: Healthscope Whirlpool |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$141.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.65
|
| Rate for Payer: Priority Health Narrow Network |
$110.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.25
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.84 |
| Max. Negotiated Rate |
$110.53 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: ASR ASR |
$107.21
|
| Rate for Payer: ASR Commercial |
$107.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.07
|
| Rate for Payer: BCN Commercial |
$85.69
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$110.53
|
| Rate for Payer: Healthscope Whirlpool |
$107.21
|
| Rate for Payer: Mclaren Commercial |
$99.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.27
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$110.53 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Aetna Medicare |
$55.26
|
| Rate for Payer: ASR ASR |
$107.21
|
| Rate for Payer: ASR Commercial |
$107.21
|
| Rate for Payer: BCBS Complete |
$44.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.51
|
| Rate for Payer: BCN Commercial |
$85.69
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$110.53
|
| Rate for Payer: Healthscope Whirlpool |
$107.21
|
| Rate for Payer: Mclaren Commercial |
$99.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.85
|
| Rate for Payer: Priority Health Narrow Network |
$77.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.27
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.37 |
| Max. Negotiated Rate |
$98.42 |
| Rate for Payer: Aetna Commercial |
$88.58
|
| Rate for Payer: Aetna Medicare |
$49.21
|
| Rate for Payer: ASR ASR |
$95.47
|
| Rate for Payer: ASR Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$39.37
|
| Rate for Payer: BCBS Trust/PPO |
$80.60
|
| Rate for Payer: BCN Commercial |
$76.31
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$92.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Healthscope Commercial |
$98.42
|
| Rate for Payer: Healthscope Whirlpool |
$95.47
|
| Rate for Payer: Mclaren Commercial |
$88.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: Nomi Health Commercial |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.24
|
| Rate for Payer: Priority Health Narrow Network |
$68.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.61
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$98.42 |
| Rate for Payer: Aetna Commercial |
$88.58
|
| Rate for Payer: ASR ASR |
$95.47
|
| Rate for Payer: ASR Commercial |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$80.20
|
| Rate for Payer: BCN Commercial |
$76.31
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$92.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Healthscope Commercial |
$98.42
|
| Rate for Payer: Healthscope Whirlpool |
$95.47
|
| Rate for Payer: Mclaren Commercial |
$88.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: Nomi Health Commercial |
$80.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.61
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,121.60 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,937.60
|
| Rate for Payer: ASR ASR |
$3,166.08
|
| Rate for Payer: ASR Commercial |
$3,166.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.83
|
| Rate for Payer: BCN Commercial |
$2,530.58
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$3,068.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Healthscope Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,166.08
|
| Rate for Payer: Mclaren Commercial |
$2,937.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: Nomi Health Commercial |
$2,676.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,872.32
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,305.60 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,937.60
|
| Rate for Payer: Aetna Medicare |
$1,632.00
|
| Rate for Payer: ASR ASR |
$3,166.08
|
| Rate for Payer: ASR Commercial |
$3,166.08
|
| Rate for Payer: BCBS Complete |
$1,305.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,672.89
|
| Rate for Payer: BCN Commercial |
$2,530.58
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$3,068.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Healthscope Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,166.08
|
| Rate for Payer: Mclaren Commercial |
$2,937.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: Nomi Health Commercial |
$2,676.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,859.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,288.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,872.32
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,016.68
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,206.67 |
| Max. Negotiated Rate |
$3,016.68 |
| Rate for Payer: Aetna Commercial |
$2,715.01
|
| Rate for Payer: Aetna Medicare |
$1,508.34
|
| Rate for Payer: ASR ASR |
$2,926.18
|
| Rate for Payer: ASR Commercial |
$2,926.18
|
| Rate for Payer: BCBS Complete |
$1,206.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,470.36
|
| Rate for Payer: BCN Commercial |
$2,338.83
|
| Rate for Payer: Cash Price |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,835.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,413.34
|
| Rate for Payer: Healthscope Commercial |
$3,016.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,926.18
|
| Rate for Payer: Mclaren Commercial |
$2,715.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.18
|
| Rate for Payer: Nomi Health Commercial |
$2,473.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,643.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,114.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,654.68
|
|
