Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE CTO

Facility

$1,511.70

Service Code	HCPCS L0200
Hospital Charge Code	27400029
Hospital Revenue Code	274
Min. Negotiated Rate	$594.10
Max. Negotiated Rate	$2,067.04
Rate for Payer: Aetna Commercial	$1,284.94
Rate for Payer: Aetna Medicare	$755.85
Rate for Payer: Aetna New Business (MI Preferred)	$982.61
Rate for Payer: BCBS Complete	$604.68
Rate for Payer: BCBS Trust/PPO	$2,067.04
Rate for Payer: BCN Commercial	$2,067.04
Rate for Payer: Cash Price	$1,209.36
Rate for Payer: Cash Price	$1,209.36
Rate for Payer: Cofinity Advantage	$1,058.19
Rate for Payer: Cofinity Commercial	$1,300.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,209.36
Rate for Payer: Healthscope Commercial	$1,360.53
Rate for Payer: MI Amish Medical Board Commercial	$1,209.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,284.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,133.78
Rate for Payer: PHP Commercial	$1,284.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$758.49
Rate for Payer: Priority Health SBD	$952.37
Rate for Payer: Priority Health Tiered Network	$606.79
Rate for Payer: UHC All Payor (Choice/PPO)	$982.61
Rate for Payer: UHC Core	$787.60
Rate for Payer: UHC Exchange	$594.10

HC BRACE CTO REPLACEMENT PADS

Facility

$280.91

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$110.40
Max. Negotiated Rate	$1,318.61
Rate for Payer: Aetna Commercial	$238.77
Rate for Payer: Aetna Medicare	$140.46
Rate for Payer: Aetna New Business (MI Preferred)	$182.59
Rate for Payer: BCBS Complete	$112.36
Rate for Payer: BCBS Trust/PPO	$1,318.61
Rate for Payer: BCN Commercial	$1,318.61
Rate for Payer: Cash Price	$224.73
Rate for Payer: Cash Price	$224.73
Rate for Payer: Cofinity Advantage	$196.64
Rate for Payer: Cofinity Commercial	$241.58
Rate for Payer: Encore Health Key Benefits Commercial	$224.73
Rate for Payer: Healthscope Commercial	$252.82
Rate for Payer: MI Amish Medical Board Commercial	$224.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.68
Rate for Payer: PHP Commercial	$238.77
Rate for Payer: Priority Health SBD	$176.97
Rate for Payer: UHC All Payor (Choice/PPO)	$182.59
Rate for Payer: UHC Core	$146.35
Rate for Payer: UHC Exchange	$110.40

HC BRACE CTO REPLACEMENT PADS

Facility

$280.91

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$176.97
Max. Negotiated Rate	$252.82
Rate for Payer: Aetna Commercial	$238.77
Rate for Payer: Aetna New Business (MI Preferred)	$182.59
Rate for Payer: Cash Price	$224.73
Rate for Payer: Cofinity Advantage	$196.64
Rate for Payer: Cofinity Commercial	$241.58
Rate for Payer: Encore Health Key Benefits Commercial	$224.73
Rate for Payer: Healthscope Commercial	$252.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.68
Rate for Payer: PHP Commercial	$238.77
Rate for Payer: Priority Health SBD	$176.97

HC BRACE D RING SPLINT

Facility

$71.79

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$64.61
Rate for Payer: Aetna Commercial	$61.02
Rate for Payer: Aetna New Business (MI Preferred)	$46.66
Rate for Payer: Cash Price	$57.43
Rate for Payer: Cofinity Advantage	$50.25
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$57.43
Rate for Payer: Healthscope Commercial	$64.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.84
Rate for Payer: PHP Commercial	$61.02
Rate for Payer: Priority Health SBD	$45.23

HC BRACE D RING SPLINT

Facility

$71.79

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$28.21
Max. Negotiated Rate	$223.46
Rate for Payer: Aetna Commercial	$61.02
Rate for Payer: Aetna Medicare	$35.90
Rate for Payer: Aetna New Business (MI Preferred)	$46.66
Rate for Payer: BCBS Complete	$28.72
Rate for Payer: BCBS Trust/PPO	$223.46
Rate for Payer: BCN Commercial	$223.46
Rate for Payer: Cash Price	$57.43
Rate for Payer: Cash Price	$57.43
Rate for Payer: Cofinity Advantage	$50.25
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$57.43
Rate for Payer: Healthscope Commercial	$64.61
Rate for Payer: MI Amish Medical Board Commercial	$57.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.84
Rate for Payer: PHP Commercial	$61.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$82.00
Rate for Payer: Priority Health SBD	$45.23
Rate for Payer: Priority Health Tiered Network	$65.60
Rate for Payer: UHC All Payor (Choice/PPO)	$46.66
Rate for Payer: UHC Core	$37.40
Rate for Payer: UHC Exchange	$28.21

HC BRACE ELBOW ORTHOSIS

Facility

$1,098.49

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$431.71
Max. Negotiated Rate	$1,524.36
Rate for Payer: Aetna Commercial	$933.72
Rate for Payer: Aetna Medicare	$549.25
Rate for Payer: Aetna New Business (MI Preferred)	$714.02
Rate for Payer: BCBS Complete	$439.40
Rate for Payer: BCBS Trust/PPO	$1,524.36
Rate for Payer: BCN Commercial	$1,524.36
Rate for Payer: Cash Price	$878.79
Rate for Payer: Cash Price	$878.79
Rate for Payer: Cofinity Advantage	$768.94
Rate for Payer: Cofinity Commercial	$944.70
Rate for Payer: Encore Health Key Benefits Commercial	$878.79
Rate for Payer: Healthscope Commercial	$988.64
Rate for Payer: MI Amish Medical Board Commercial	$878.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$933.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$823.87
Rate for Payer: PHP Commercial	$933.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$559.36
Rate for Payer: Priority Health SBD	$692.05
Rate for Payer: Priority Health Tiered Network	$447.49
Rate for Payer: UHC All Payor (Choice/PPO)	$714.02
Rate for Payer: UHC Core	$572.31
Rate for Payer: UHC Exchange	$431.71

HC BRACE ELBOW ORTHOSIS

Facility

$1,098.49

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$692.05
Max. Negotiated Rate	$988.64
Rate for Payer: Aetna Commercial	$933.72
Rate for Payer: Aetna New Business (MI Preferred)	$714.02
Rate for Payer: Cash Price	$878.79
Rate for Payer: Cofinity Advantage	$768.94
Rate for Payer: Cofinity Commercial	$944.70
Rate for Payer: Encore Health Key Benefits Commercial	$878.79
Rate for Payer: Healthscope Commercial	$988.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$933.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$823.87
Rate for Payer: PHP Commercial	$933.72
Rate for Payer: Priority Health SBD	$692.05

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$712.67

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$448.98
Max. Negotiated Rate	$641.40
Rate for Payer: Aetna Commercial	$605.77
Rate for Payer: Aetna New Business (MI Preferred)	$463.24
Rate for Payer: Cash Price	$570.14
Rate for Payer: Cofinity Advantage	$498.87
Rate for Payer: Cofinity Commercial	$612.90
Rate for Payer: Encore Health Key Benefits Commercial	$570.14
Rate for Payer: Healthscope Commercial	$641.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$605.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.50
Rate for Payer: PHP Commercial	$605.77
Rate for Payer: Priority Health SBD	$448.98

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$712.67

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$280.08
Max. Negotiated Rate	$2,280.97
Rate for Payer: Aetna Commercial	$605.77
Rate for Payer: Aetna Medicare	$356.33
Rate for Payer: Aetna New Business (MI Preferred)	$463.24
Rate for Payer: BCBS Complete	$285.07
Rate for Payer: BCBS Trust/PPO	$2,280.97
Rate for Payer: BCN Commercial	$2,280.97
Rate for Payer: Cash Price	$570.14
Rate for Payer: Cash Price	$570.14
Rate for Payer: Cofinity Advantage	$498.87
Rate for Payer: Cofinity Commercial	$612.90
Rate for Payer: Encore Health Key Benefits Commercial	$570.14
Rate for Payer: Healthscope Commercial	$641.40
Rate for Payer: MI Amish Medical Board Commercial	$570.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$605.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.50
Rate for Payer: PHP Commercial	$605.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$836.99
Rate for Payer: Priority Health SBD	$448.98
Rate for Payer: Priority Health Tiered Network	$669.59
Rate for Payer: UHC All Payor (Choice/PPO)	$463.24
Rate for Payer: UHC Core	$371.30
Rate for Payer: UHC Exchange	$280.08

HC BRACE FOREFOOT RELIEF SHOE

Facility

$41.62

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$16.36
Max. Negotiated Rate	$67.37
Rate for Payer: Aetna Commercial	$35.38
Rate for Payer: Aetna Medicare	$20.81
Rate for Payer: Aetna New Business (MI Preferred)	$27.05
Rate for Payer: BCBS Complete	$16.65
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Advantage	$29.13
Rate for Payer: Cofinity Commercial	$35.79
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$37.46
Rate for Payer: MI Amish Medical Board Commercial	$33.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: PHP Commercial	$35.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$67.37
Rate for Payer: Priority Health SBD	$26.22
Rate for Payer: Priority Health Tiered Network	$53.90
Rate for Payer: UHC All Payor (Choice/PPO)	$27.05
Rate for Payer: UHC Core	$21.68
Rate for Payer: UHC Exchange	$16.36

HC BRACE FOREFOOT RELIEF SHOE

Facility

$41.62

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$26.22
Max. Negotiated Rate	$37.46
Rate for Payer: Aetna Commercial	$35.38
Rate for Payer: Aetna New Business (MI Preferred)	$27.05
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cofinity Advantage	$29.13
Rate for Payer: Cofinity Commercial	$35.79
Rate for Payer: Encore Health Key Benefits Commercial	$33.30
Rate for Payer: Healthscope Commercial	$37.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.21
Rate for Payer: PHP Commercial	$35.38
Rate for Payer: Priority Health SBD	$26.22

HC BRACE FO W/O JOINTS CF

Facility

$203.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$80.14
Max. Negotiated Rate	$650.34
Rate for Payer: Aetna Commercial	$173.33
Rate for Payer: Aetna Medicare	$101.96
Rate for Payer: Aetna New Business (MI Preferred)	$132.55
Rate for Payer: BCBS Complete	$81.57
Rate for Payer: BCBS Trust/PPO	$650.34
Rate for Payer: BCN Commercial	$650.34
Rate for Payer: Cash Price	$163.14
Rate for Payer: Cash Price	$163.14
Rate for Payer: Cofinity Advantage	$142.74
Rate for Payer: Cofinity Commercial	$175.37
Rate for Payer: Encore Health Key Benefits Commercial	$163.14
Rate for Payer: Healthscope Commercial	$183.53
Rate for Payer: MI Amish Medical Board Commercial	$163.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$152.94
Rate for Payer: PHP Commercial	$173.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$238.64
Rate for Payer: Priority Health SBD	$128.47
Rate for Payer: Priority Health Tiered Network	$190.91
Rate for Payer: UHC All Payor (Choice/PPO)	$132.55
Rate for Payer: UHC Core	$106.24
Rate for Payer: UHC Exchange	$80.14

HC BRACE FO W/O JOINTS CF

Facility

$203.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$128.47
Max. Negotiated Rate	$183.53
Rate for Payer: Aetna Commercial	$173.33
Rate for Payer: Aetna New Business (MI Preferred)	$132.55
Rate for Payer: Cash Price	$163.14
Rate for Payer: Cofinity Advantage	$142.74
Rate for Payer: Cofinity Commercial	$175.37
Rate for Payer: Encore Health Key Benefits Commercial	$163.14
Rate for Payer: Healthscope Commercial	$183.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$152.94
Rate for Payer: PHP Commercial	$173.33
Rate for Payer: Priority Health SBD	$128.47

HC BRACE FRACTURE BOOT CUSTOM

Facility

$431.11

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$271.60
Max. Negotiated Rate	$388.00
Rate for Payer: Aetna Commercial	$366.44
Rate for Payer: Aetna New Business (MI Preferred)	$280.22
Rate for Payer: Cash Price	$344.89
Rate for Payer: Cofinity Advantage	$301.78
Rate for Payer: Cofinity Commercial	$370.75
Rate for Payer: Encore Health Key Benefits Commercial	$344.89
Rate for Payer: Healthscope Commercial	$388.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$323.33
Rate for Payer: PHP Commercial	$366.44
Rate for Payer: Priority Health SBD	$271.60

HC BRACE FRACTURE BOOT CUSTOM

Facility

$431.11

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$155.89
Max. Negotiated Rate	$531.03
Rate for Payer: Aetna Commercial	$366.44
Rate for Payer: Aetna Medicare	$215.56
Rate for Payer: Aetna New Business (MI Preferred)	$280.22
Rate for Payer: BCBS Complete	$172.44
Rate for Payer: BCBS Trust/PPO	$531.03
Rate for Payer: BCN Commercial	$531.03
Rate for Payer: Cash Price	$344.89
Rate for Payer: Cash Price	$344.89
Rate for Payer: Cofinity Advantage	$301.78
Rate for Payer: Cofinity Commercial	$370.75
Rate for Payer: Encore Health Key Benefits Commercial	$344.89
Rate for Payer: Healthscope Commercial	$388.00
Rate for Payer: MI Amish Medical Board Commercial	$344.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$323.33
Rate for Payer: PHP Commercial	$366.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$194.86
Rate for Payer: Priority Health SBD	$271.60
Rate for Payer: Priority Health Tiered Network	$155.89
Rate for Payer: UHC All Payor (Choice/PPO)	$280.22
Rate for Payer: UHC Core	$224.61
Rate for Payer: UHC Exchange	$169.43

HC BRACE FRACTURE BOOT OTS

Facility

$517.32

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$325.91
Max. Negotiated Rate	$465.59
Rate for Payer: Aetna Commercial	$439.72
Rate for Payer: Aetna New Business (MI Preferred)	$336.26
Rate for Payer: Cash Price	$413.86
Rate for Payer: Cofinity Advantage	$362.12
Rate for Payer: Cofinity Commercial	$444.90
Rate for Payer: Encore Health Key Benefits Commercial	$413.86
Rate for Payer: Healthscope Commercial	$465.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$439.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.99
Rate for Payer: PHP Commercial	$439.72
Rate for Payer: Priority Health SBD	$325.91

HC BRACE FRACTURE BOOT OTS

Facility

$517.32

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$155.89
Max. Negotiated Rate	$465.59
Rate for Payer: Aetna Commercial	$439.72
Rate for Payer: Aetna Medicare	$258.66
Rate for Payer: Aetna New Business (MI Preferred)	$336.26
Rate for Payer: BCBS Complete	$206.93
Rate for Payer: Cash Price	$413.86
Rate for Payer: Cash Price	$413.86
Rate for Payer: Cofinity Advantage	$362.12
Rate for Payer: Cofinity Commercial	$444.90
Rate for Payer: Encore Health Key Benefits Commercial	$413.86
Rate for Payer: Healthscope Commercial	$465.59
Rate for Payer: MI Amish Medical Board Commercial	$413.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$439.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.99
Rate for Payer: PHP Commercial	$439.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$194.86
Rate for Payer: Priority Health SBD	$325.91
Rate for Payer: Priority Health Tiered Network	$155.89
Rate for Payer: UHC All Payor (Choice/PPO)	$336.26
Rate for Payer: UHC Core	$269.52
Rate for Payer: UHC Exchange	$203.31

HC BRACE HAND/FINGER ORTHOSIS

Facility

$305.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$192.70
Max. Negotiated Rate	$275.29
Rate for Payer: Aetna Commercial	$260.00
Rate for Payer: Aetna New Business (MI Preferred)	$198.82
Rate for Payer: Cash Price	$244.70
Rate for Payer: Cofinity Advantage	$214.12
Rate for Payer: Cofinity Commercial	$263.06
Rate for Payer: Encore Health Key Benefits Commercial	$244.70
Rate for Payer: Healthscope Commercial	$275.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.41
Rate for Payer: PHP Commercial	$260.00
Rate for Payer: Priority Health SBD	$192.70

HC BRACE HAND/FINGER ORTHOSIS

Facility

$305.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$120.21
Max. Negotiated Rate	$979.12
Rate for Payer: Aetna Commercial	$260.00
Rate for Payer: Aetna Medicare	$152.94
Rate for Payer: Aetna New Business (MI Preferred)	$198.82
Rate for Payer: BCBS Complete	$122.35
Rate for Payer: BCBS Trust/PPO	$979.12
Rate for Payer: BCN Commercial	$979.12
Rate for Payer: Cash Price	$244.70
Rate for Payer: Cash Price	$244.70
Rate for Payer: Cofinity Advantage	$214.12
Rate for Payer: Cofinity Commercial	$263.06
Rate for Payer: Encore Health Key Benefits Commercial	$244.70
Rate for Payer: Healthscope Commercial	$275.29
Rate for Payer: MI Amish Medical Board Commercial	$244.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$260.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.41
Rate for Payer: PHP Commercial	$260.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$359.28
Rate for Payer: Priority Health SBD	$192.70
Rate for Payer: Priority Health Tiered Network	$287.42
Rate for Payer: UHC All Payor (Choice/PPO)	$198.82
Rate for Payer: UHC Core	$159.36
Rate for Payer: UHC Exchange	$120.21

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$524.24

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$206.03
Max. Negotiated Rate	$825.46
Rate for Payer: Aetna Commercial	$445.60
Rate for Payer: Aetna Medicare	$262.12
Rate for Payer: Aetna New Business (MI Preferred)	$340.76
Rate for Payer: BCBS Complete	$209.70
Rate for Payer: BCBS Trust/PPO	$825.46
Rate for Payer: BCN Commercial	$825.46
Rate for Payer: Cash Price	$419.39
Rate for Payer: Cash Price	$419.39
Rate for Payer: Cofinity Advantage	$366.97
Rate for Payer: Cofinity Commercial	$450.85
Rate for Payer: Encore Health Key Benefits Commercial	$419.39
Rate for Payer: Healthscope Commercial	$471.82
Rate for Payer: MI Amish Medical Board Commercial	$419.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$445.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.18
Rate for Payer: PHP Commercial	$445.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$302.90
Rate for Payer: Priority Health SBD	$330.27
Rate for Payer: Priority Health Tiered Network	$242.32
Rate for Payer: UHC All Payor (Choice/PPO)	$340.76
Rate for Payer: UHC Core	$273.13
Rate for Payer: UHC Exchange	$206.03

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$524.24

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$330.27
Max. Negotiated Rate	$471.82
Rate for Payer: Aetna Commercial	$445.60
Rate for Payer: Aetna New Business (MI Preferred)	$340.76
Rate for Payer: Cash Price	$419.39
Rate for Payer: Cofinity Advantage	$366.97
Rate for Payer: Cofinity Commercial	$450.85
Rate for Payer: Encore Health Key Benefits Commercial	$419.39
Rate for Payer: Healthscope Commercial	$471.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$445.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.18
Rate for Payer: PHP Commercial	$445.60
Rate for Payer: Priority Health SBD	$330.27

HC BRACE HARD HELMET

Facility

$429.21

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$270.40
Max. Negotiated Rate	$386.29
Rate for Payer: Aetna Commercial	$364.83
Rate for Payer: Aetna New Business (MI Preferred)	$278.99
Rate for Payer: Cash Price	$343.37
Rate for Payer: Cofinity Advantage	$300.45
Rate for Payer: Cofinity Commercial	$369.12
Rate for Payer: Encore Health Key Benefits Commercial	$343.37
Rate for Payer: Healthscope Commercial	$386.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$321.91
Rate for Payer: PHP Commercial	$364.83
Rate for Payer: Priority Health SBD	$270.40

HC BRACE HARD HELMET

Facility

$429.21

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$168.68
Max. Negotiated Rate	$386.29
Rate for Payer: Aetna Commercial	$364.83
Rate for Payer: Aetna Medicare	$214.60
Rate for Payer: Aetna New Business (MI Preferred)	$278.99
Rate for Payer: BCBS Complete	$171.68
Rate for Payer: Cash Price	$343.37
Rate for Payer: Cash Price	$343.37
Rate for Payer: Cofinity Advantage	$300.45
Rate for Payer: Cofinity Commercial	$369.12
Rate for Payer: Encore Health Key Benefits Commercial	$343.37
Rate for Payer: Healthscope Commercial	$386.29
Rate for Payer: MI Amish Medical Board Commercial	$343.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$321.91
Rate for Payer: PHP Commercial	$364.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$218.57
Rate for Payer: Priority Health SBD	$270.40
Rate for Payer: Priority Health Tiered Network	$174.86
Rate for Payer: UHC All Payor (Choice/PPO)	$278.99
Rate for Payer: UHC Core	$223.62
Rate for Payer: UHC Exchange	$168.68

HC BRACE HEEL RELIEF SHOE

Facility

$187.27

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$117.98
Max. Negotiated Rate	$168.54
Rate for Payer: Aetna Commercial	$159.18
Rate for Payer: Aetna New Business (MI Preferred)	$121.73
Rate for Payer: Cash Price	$149.82
Rate for Payer: Cofinity Advantage	$131.09
Rate for Payer: Cofinity Commercial	$161.05
Rate for Payer: Encore Health Key Benefits Commercial	$149.82
Rate for Payer: Healthscope Commercial	$168.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$140.45
Rate for Payer: PHP Commercial	$159.18
Rate for Payer: Priority Health SBD	$117.98

HC BRACE HEEL RELIEF SHOE

Facility

$187.27

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$168.54
Rate for Payer: Aetna Commercial	$159.18
Rate for Payer: Aetna Medicare	$93.64
Rate for Payer: Aetna New Business (MI Preferred)	$121.73
Rate for Payer: BCBS Complete	$74.91
Rate for Payer: BCBS Trust/PPO	$166.78
Rate for Payer: BCN Commercial	$166.78
Rate for Payer: Cash Price	$149.82
Rate for Payer: Cash Price	$149.82
Rate for Payer: Cofinity Advantage	$131.09
Rate for Payer: Cofinity Commercial	$161.05
Rate for Payer: Encore Health Key Benefits Commercial	$149.82
Rate for Payer: Healthscope Commercial	$168.54
Rate for Payer: MI Amish Medical Board Commercial	$149.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$140.45
Rate for Payer: PHP Commercial	$159.18
Rate for Payer: Priority Health SBD	$117.98
Rate for Payer: UHC All Payor (Choice/PPO)	$121.73
Rate for Payer: UHC Core	$97.57
Rate for Payer: UHC Exchange	$73.60

Know your out-of-pocket cost for care.

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