|
HC OT Z GAUNTLET EA $80
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$30.80
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$68.62
|
| Rate for Payer: BCN Commercial |
$68.62
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$80.73
|
| Rate for Payer: Healthscope Whirlpool |
$83.23
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC OT Z GAUNTLET EA $90
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC OT Z GAUNTLET EA $90
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC OT Z SLEEVE OR GLOVE EA $100
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.44
|
| Rate for Payer: BCN Commercial |
$85.44
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC OT Z SLEEVE OR GLOVE EA $100
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$85.78
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.16
|
| Rate for Payer: Priority Health Narrow Network |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC OT Z SLEEVE OR GLOVE EA $125
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Trust/PPO |
$106.80
|
| Rate for Payer: BCN Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC OT Z SLEEVE OR GLOVE EA $125
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$107.23
|
| Rate for Payer: BCN Commercial |
$107.23
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.95
|
| Rate for Payer: Priority Health Narrow Network |
$91.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC OT Z SLEEVE OR GLOVE EA $150
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC OT Z SLEEVE OR GLOVE EA $150
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC OT Z SLEEVE OR GLOVE EA $175
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.55 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Trust/PPO |
$149.52
|
| Rate for Payer: BCN Commercial |
$149.52
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
|
|
HC OT Z SLEEVE OR GLOVE EA $175
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: Aetna Medicare |
$67.37
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Complete |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.12
|
| Rate for Payer: BCN Commercial |
$150.12
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.53
|
| Rate for Payer: Priority Health Narrow Network |
$127.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.06 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: BCBS Trust/PPO |
$170.88
|
| Rate for Payer: BCN Commercial |
$170.88
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.84
|
| Rate for Payer: Healthscope Whirlpool |
$208.08
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$171.56
|
| Rate for Payer: BCN Commercial |
$171.56
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.84
|
| Rate for Payer: Healthscope Whirlpool |
$208.08
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.32
|
| Rate for Payer: Priority Health Narrow Network |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: Aetna Medicare |
$86.61
|
| Rate for Payer: ASR ASR |
$227.07
|
| Rate for Payer: BCBS Complete |
$93.64
|
| Rate for Payer: BCBS Trust/PPO |
$193.01
|
| Rate for Payer: BCN Commercial |
$193.01
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$227.07
|
| Rate for Payer: Healthscope Whirlpool |
$234.09
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.11
|
| Rate for Payer: Priority Health Narrow Network |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
IP
|
$234.09
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.57 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: ASR ASR |
$227.07
|
| Rate for Payer: BCBS Trust/PPO |
$192.23
|
| Rate for Payer: BCN Commercial |
$192.23
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$227.07
|
| Rate for Payer: Healthscope Whirlpool |
$234.09
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.07 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: BCBS Trust/PPO |
$213.59
|
| Rate for Payer: BCN Commercial |
$213.59
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$252.30
|
| Rate for Payer: Healthscope Whirlpool |
$260.10
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.24 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$96.24
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: BCBS Complete |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$214.45
|
| Rate for Payer: BCN Commercial |
$214.45
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$252.30
|
| Rate for Payer: Healthscope Whirlpool |
$260.10
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.90
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$105.86
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$235.90
|
| Rate for Payer: BCN Commercial |
$235.90
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$234.95
|
| Rate for Payer: BCN Commercial |
$234.95
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$256.31
|
| Rate for Payer: BCN Commercial |
$256.31
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Complete |
$124.85
|
| Rate for Payer: BCBS Trust/PPO |
$257.34
|
| Rate for Payer: BCN Commercial |
$257.34
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
IP
|
$338.13
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$338.13 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: ASR ASR |
$327.99
|
| Rate for Payer: BCBS Trust/PPO |
$277.67
|
| Rate for Payer: BCN Commercial |
$277.67
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$317.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Healthscope Commercial |
$327.99
|
| Rate for Payer: Healthscope Whirlpool |
$338.13
|
| Rate for Payer: Mclaren Commercial |
$304.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Nomi Health Commercial |
$277.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.55
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
OP
|
$338.13
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$338.13 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: Aetna Medicare |
$125.11
|
| Rate for Payer: ASR ASR |
$327.99
|
| Rate for Payer: BCBS Complete |
$135.25
|
| Rate for Payer: BCBS Trust/PPO |
$278.79
|
| Rate for Payer: BCN Commercial |
$278.79
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$317.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Healthscope Commercial |
$327.99
|
| Rate for Payer: Healthscope Whirlpool |
$338.13
|
| Rate for Payer: Mclaren Commercial |
$304.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Nomi Health Commercial |
$277.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.27
|
| Rate for Payer: Priority Health Narrow Network |
$237.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.55
|
|
