|
HC OT Z SLEEVE OR GLOVE EA $100
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: ASR Commercial |
$98.94
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$83.53
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.37
|
| Rate for Payer: Priority Health Narrow Network |
$71.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC OT Z SLEEVE OR GLOVE EA $125
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000027
|
|
Hospital Revenue Code
|
270
|
| 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 |
$123.68
|
| Rate for Payer: ASR Commercial |
$123.68
|
| 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 |
$123.68
|
| 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 OT Z SLEEVE OR GLOVE EA $125
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: ASR ASR |
$123.68
|
| Rate for Payer: ASR Commercial |
$123.68
|
| 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 |
$123.68
|
| 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 OT Z SLEEVE OR GLOVE EA $150
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC OT Z SLEEVE OR GLOVE EA $150
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC OT Z SLEEVE OR GLOVE EA $175
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: ASR ASR |
$173.14
|
| Rate for Payer: ASR Commercial |
$173.14
|
| Rate for Payer: BCBS Trust/PPO |
$145.46
|
| Rate for Payer: BCN Commercial |
$138.39
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$178.50
|
| Rate for Payer: Healthscope Whirlpool |
$173.14
|
| Rate for Payer: Mclaren Commercial |
$160.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.08
|
|
|
HC OT Z SLEEVE OR GLOVE EA $175
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: ASR ASR |
$173.14
|
| Rate for Payer: ASR Commercial |
$173.14
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: BCBS Trust/PPO |
$146.17
|
| Rate for Payer: BCN Commercial |
$138.39
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$178.50
|
| Rate for Payer: Healthscope Whirlpool |
$173.14
|
| Rate for Payer: Mclaren Commercial |
$160.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.40
|
| Rate for Payer: Priority Health Narrow Network |
$125.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.08
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.71
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: ASR Commercial |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: ASR Commercial |
$197.88
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$167.06
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: Nomi Health Commercial |
$167.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.74
|
| Rate for Payer: Priority Health Narrow Network |
$143.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: ASR Commercial |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$166.24
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: Nomi Health Commercial |
$167.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: ASR ASR |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.09
|
| Rate for Payer: Priority Health Narrow Network |
$160.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.96
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: ASR ASR |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.96
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: ASR Commercial |
$247.35
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$208.82
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.43
|
| Rate for Payer: Priority Health Narrow Network |
$178.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: ASR Commercial |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$207.80
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: ASR Commercial |
$296.82
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$250.58
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.12
|
| Rate for Payer: Priority Health Narrow Network |
$214.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: ASR Commercial |
$296.82
|
| Rate for Payer: BCBS Trust/PPO |
$249.36
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
OP
|
$331.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Commercial |
$298.35
|
| Rate for Payer: Aetna Medicare |
$165.75
|
| Rate for Payer: ASR ASR |
$321.56
|
| Rate for Payer: ASR Commercial |
$321.56
|
| Rate for Payer: BCBS Complete |
$132.60
|
| Rate for Payer: BCBS Trust/PPO |
$271.47
|
| Rate for Payer: BCN Commercial |
$257.01
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$311.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$331.50
|
| Rate for Payer: Healthscope Whirlpool |
$321.56
|
| Rate for Payer: Mclaren Commercial |
$298.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: Nomi Health Commercial |
$271.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.46
|
| Rate for Payer: Priority Health Narrow Network |
$232.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.72
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
IP
|
$331.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.48 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Commercial |
$298.35
|
| Rate for Payer: ASR ASR |
$321.56
|
| Rate for Payer: ASR Commercial |
$321.56
|
| Rate for Payer: BCBS Trust/PPO |
$270.14
|
| Rate for Payer: BCN Commercial |
$257.01
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$311.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$331.50
|
| Rate for Payer: Healthscope Whirlpool |
$321.56
|
| Rate for Payer: Mclaren Commercial |
$298.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: Nomi Health Commercial |
$271.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.72
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: ASR ASR |
$346.29
|
| Rate for Payer: ASR Commercial |
$346.29
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$292.35
|
| Rate for Payer: BCN Commercial |
$276.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$335.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$357.00
|
| Rate for Payer: Healthscope Whirlpool |
$346.29
|
| Rate for Payer: Mclaren Commercial |
$321.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: Nomi Health Commercial |
$292.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.80
|
| Rate for Payer: Priority Health Narrow Network |
$250.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.16
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: ASR ASR |
$346.29
|
| Rate for Payer: ASR Commercial |
$346.29
|
| Rate for Payer: BCBS Trust/PPO |
$290.92
|
| Rate for Payer: BCN Commercial |
$276.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$335.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$357.00
|
| Rate for Payer: Healthscope Whirlpool |
$346.29
|
| Rate for Payer: Mclaren Commercial |
$321.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: Nomi Health Commercial |
$292.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.16
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
IP
|
$382.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$248.62 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: ASR ASR |
$371.02
|
| Rate for Payer: ASR Commercial |
$371.02
|
| Rate for Payer: BCBS Trust/PPO |
$311.70
|
| Rate for Payer: BCN Commercial |
$296.55
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Healthscope Whirlpool |
$371.02
|
| Rate for Payer: Mclaren Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.60
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
OP
|
$382.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: Aetna Medicare |
$191.25
|
| Rate for Payer: ASR ASR |
$371.02
|
| Rate for Payer: ASR Commercial |
$371.02
|
| Rate for Payer: BCBS Complete |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.23
|
| Rate for Payer: BCN Commercial |
$296.55
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Healthscope Whirlpool |
$371.02
|
| Rate for Payer: Mclaren Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.15
|
| Rate for Payer: Priority Health Narrow Network |
$268.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.60
|
|
