|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: ASR Commercial |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: ASR Commercial |
$395.76
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$334.11
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.49
|
| Rate for Payer: Priority Health Narrow Network |
$286.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: ASR Commercial |
$395.76
|
| Rate for Payer: BCBS Trust/PPO |
$332.48
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.78 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: ASR ASR |
$420.50
|
| Rate for Payer: ASR Commercial |
$420.50
|
| Rate for Payer: BCBS Trust/PPO |
$353.26
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$407.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$433.50
|
| Rate for Payer: Healthscope Whirlpool |
$420.50
|
| Rate for Payer: Mclaren Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.48
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$216.75
|
| Rate for Payer: ASR ASR |
$420.50
|
| Rate for Payer: ASR Commercial |
$420.50
|
| Rate for Payer: BCBS Complete |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$354.99
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$407.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$433.50
|
| Rate for Payer: Healthscope Whirlpool |
$420.50
|
| Rate for Payer: Mclaren Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.83
|
| Rate for Payer: Priority Health Narrow Network |
$303.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.48
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: ASR Commercial |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| 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: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
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 STOCKINGS CUSTOM EA $125
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
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 STOCKINGS CUSTOM EA $125
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
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 STOCKINGS CUSTOM EA $150
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
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 STOCKINGS CUSTOM EA $150
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
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 STOCKINGS CUSTOM EA $175
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300097
|
|
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
|
|
