|
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
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,302.30 |
| Max. Negotiated Rate |
$2,003.54 |
| Rate for Payer: Aetna Commercial |
$1,803.19
|
| Rate for Payer: ASR ASR |
$1,943.43
|
| Rate for Payer: ASR Commercial |
$1,943.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.68
|
| Rate for Payer: BCN Commercial |
$1,553.34
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,883.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Healthscope Commercial |
$2,003.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,943.43
|
| Rate for Payer: Mclaren Commercial |
$1,803.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: Nomi Health Commercial |
$1,642.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.12
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$801.42 |
| Max. Negotiated Rate |
$2,003.54 |
| Rate for Payer: Aetna Commercial |
$1,803.19
|
| Rate for Payer: Aetna Medicare |
$1,001.77
|
| Rate for Payer: ASR ASR |
$1,943.43
|
| Rate for Payer: ASR Commercial |
$1,943.43
|
| Rate for Payer: BCBS Complete |
$801.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.70
|
| Rate for Payer: BCN Commercial |
$1,553.34
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,883.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Healthscope Commercial |
$2,003.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,943.43
|
| Rate for Payer: Mclaren Commercial |
$1,803.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: Nomi Health Commercial |
$1,642.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,755.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,404.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.12
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.01
|
| Rate for Payer: Priority Health Narrow Network |
$33.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna Commercial |
$32.54
|
| Rate for Payer: ASR ASR |
$35.07
|
| Rate for Payer: ASR Commercial |
$35.07
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$28.03
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$36.15
|
| Rate for Payer: Healthscope Whirlpool |
$35.07
|
| Rate for Payer: Mclaren Commercial |
$32.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: Nomi Health Commercial |
$29.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.81
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna Commercial |
$32.54
|
| Rate for Payer: Aetna Medicare |
$18.08
|
| Rate for Payer: ASR ASR |
$35.07
|
| Rate for Payer: ASR Commercial |
$35.07
|
| Rate for Payer: BCBS Complete |
$14.46
|
| Rate for Payer: BCBS Trust/PPO |
$29.60
|
| Rate for Payer: BCN Commercial |
$28.03
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$36.15
|
| Rate for Payer: Healthscope Whirlpool |
$35.07
|
| Rate for Payer: Mclaren Commercial |
$32.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: Nomi Health Commercial |
$29.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.67
|
| Rate for Payer: Priority Health Narrow Network |
$25.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.81
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$147.52 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: ASR ASR |
$143.09
|
| Rate for Payer: ASR Commercial |
$143.09
|
| Rate for Payer: BCBS Trust/PPO |
$120.21
|
| Rate for Payer: BCN Commercial |
$114.37
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$138.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$147.52
|
| Rate for Payer: Healthscope Whirlpool |
$143.09
|
| Rate for Payer: Mclaren Commercial |
$132.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.82
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$147.52 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$73.76
|
| Rate for Payer: ASR ASR |
$143.09
|
| Rate for Payer: ASR Commercial |
$143.09
|
| Rate for Payer: BCBS Complete |
$59.01
|
| Rate for Payer: BCBS Trust/PPO |
$120.80
|
| Rate for Payer: BCN Commercial |
$114.37
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$138.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$147.52
|
| Rate for Payer: Healthscope Whirlpool |
$143.09
|
| Rate for Payer: Mclaren Commercial |
$132.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.26
|
| Rate for Payer: Priority Health Narrow Network |
$103.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.82
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.67 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: Aetna Commercial |
$305.25
|
| Rate for Payer: Aetna Medicare |
$169.58
|
| Rate for Payer: ASR ASR |
$328.99
|
| Rate for Payer: ASR Commercial |
$328.99
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: BCBS Trust/PPO |
$277.75
|
| Rate for Payer: BCN Commercial |
$262.96
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$318.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$339.17
|
| Rate for Payer: Healthscope Whirlpool |
$328.99
|
| Rate for Payer: Mclaren Commercial |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.18
|
| Rate for Payer: Priority Health Narrow Network |
$237.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.47
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: Aetna Commercial |
$305.25
|
| Rate for Payer: ASR ASR |
$328.99
|
| Rate for Payer: ASR Commercial |
$328.99
|
| Rate for Payer: BCBS Trust/PPO |
$276.39
|
| Rate for Payer: BCN Commercial |
$262.96
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$318.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$339.17
|
| Rate for Payer: Healthscope Whirlpool |
$328.99
|
| Rate for Payer: Mclaren Commercial |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.47
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.79 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$434.48
|
| Rate for Payer: ASR ASR |
$468.27
|
| Rate for Payer: ASR Commercial |
$468.27
|
| Rate for Payer: BCBS Trust/PPO |
$393.39
|
| Rate for Payer: BCN Commercial |
$374.28
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$453.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$482.75
|
| Rate for Payer: Healthscope Whirlpool |
$468.27
|
| Rate for Payer: Mclaren Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.82
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.10 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$434.48
|
| Rate for Payer: Aetna Medicare |
$241.38
|
| Rate for Payer: ASR ASR |
$468.27
|
| Rate for Payer: ASR Commercial |
$468.27
|
| Rate for Payer: BCBS Complete |
$193.10
|
| Rate for Payer: BCBS Trust/PPO |
$395.32
|
| Rate for Payer: BCN Commercial |
$374.28
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$453.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$482.75
|
| Rate for Payer: Healthscope Whirlpool |
$468.27
|
| Rate for Payer: Mclaren Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.99
|
| Rate for Payer: Priority Health Narrow Network |
$338.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.82
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$926.16 |
| Max. Negotiated Rate |
$2,315.40 |
| Rate for Payer: Aetna Commercial |
$2,083.86
|
| Rate for Payer: Aetna Medicare |
$1,157.70
|
| Rate for Payer: ASR ASR |
$2,245.94
|
| Rate for Payer: ASR Commercial |
$2,245.94
|
| Rate for Payer: BCBS Complete |
$926.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,896.08
|
| Rate for Payer: BCN Commercial |
$1,795.13
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$2,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,315.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,245.94
|
| Rate for Payer: Mclaren Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,028.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,623.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,037.55
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.01 |
| Max. Negotiated Rate |
$2,315.40 |
| Rate for Payer: Aetna Commercial |
$2,083.86
|
| Rate for Payer: ASR ASR |
$2,245.94
|
| Rate for Payer: ASR Commercial |
$2,245.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.82
|
| Rate for Payer: BCN Commercial |
$1,795.13
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$2,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,315.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,245.94
|
| Rate for Payer: Mclaren Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,037.55
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: ASR ASR |
$148.45
|
| Rate for Payer: ASR Commercial |
$148.45
|
| Rate for Payer: BCBS Trust/PPO |
$124.71
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$143.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Healthscope Whirlpool |
$148.45
|
| Rate for Payer: Mclaren Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.68
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: Aetna Medicare |
$76.52
|
| Rate for Payer: ASR ASR |
$148.45
|
| Rate for Payer: ASR Commercial |
$148.45
|
| Rate for Payer: BCBS Complete |
$61.22
|
| Rate for Payer: BCBS Trust/PPO |
$125.32
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$143.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Healthscope Whirlpool |
$148.45
|
| Rate for Payer: Mclaren Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.09
|
| Rate for Payer: Priority Health Narrow Network |
$107.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.68
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Trust/PPO |
$182.71
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: Aetna Medicare |
$34.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.00
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: BCBS MAPPO |
$34.40
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: BCN Medicare Advantage |
$34.40
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.40
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Mclaren Medicaid |
$18.44
|
| Rate for Payer: Mclaren Medicare |
$34.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.12
|
| Rate for Payer: Meridian Medicaid |
$19.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: PACE Medicare |
$32.68
|
| Rate for Payer: PACE SWMI |
$34.40
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: PHP Medicaid |
$18.44
|
| Rate for Payer: PHP Medicare Advantage |
$34.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.45
|
| Rate for Payer: Priority Health Medicare |
$34.40
|
| Rate for Payer: Priority Health Narrow Network |
$157.17
|
| Rate for Payer: Railroad Medicare Medicare |
$34.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.40
|
| Rate for Payer: UHC Exchange |
$53.32
|
| Rate for Payer: UHC Medicare Advantage |
$34.40
|
| Rate for Payer: UHCCP DNSP |
$34.40
|
| Rate for Payer: UHCCP Medicaid |
$18.44
|
| Rate for Payer: VA VA |
$34.40
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.45 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,608.16
|
| Rate for Payer: ASR ASR |
$1,733.24
|
| Rate for Payer: ASR Commercial |
$1,733.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.10
|
| Rate for Payer: BCN Commercial |
$1,385.34
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,679.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,733.24
|
| Rate for Payer: Mclaren Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,572.43
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.74 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,608.16
|
| Rate for Payer: Aetna Medicare |
$893.42
|
| Rate for Payer: ASR ASR |
$1,733.24
|
| Rate for Payer: ASR Commercial |
$1,733.24
|
| Rate for Payer: BCBS Complete |
$714.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.25
|
| Rate for Payer: BCN Commercial |
$1,385.34
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,679.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,733.24
|
| Rate for Payer: Mclaren Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,565.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,572.43
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$209.18 |
| Max. Negotiated Rate |
$5,179.22 |
| Rate for Payer: Aetna Commercial |
$4,661.30
|
| Rate for Payer: Aetna Medicare |
$2,589.61
|
| Rate for Payer: ASR ASR |
$5,023.84
|
| Rate for Payer: ASR Commercial |
$5,023.84
|
| Rate for Payer: BCBS Complete |
$2,071.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,241.26
|
| Rate for Payer: BCCCP Commercial |
$524.38
|
| Rate for Payer: BCN Commercial |
$4,015.45
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,868.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$5,179.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,023.84
|
| Rate for Payer: Mclaren Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.47
|
| Rate for Payer: Priority Health Narrow Network |
$209.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,557.71
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.49 |
| Max. Negotiated Rate |
$5,179.22 |
| Rate for Payer: Aetna Commercial |
$4,661.30
|
| Rate for Payer: ASR ASR |
$5,023.84
|
| Rate for Payer: ASR Commercial |
$5,023.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,220.55
|
| Rate for Payer: BCN Commercial |
$4,015.45
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,868.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$5,179.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,023.84
|
| Rate for Payer: Mclaren Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,557.71
|
|
