Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE ASPEN COLLAR

Facility

$341.80

Service Code	HCPCS L0172
Hospital Charge Code	27000011
Hospital Revenue Code	274
Min. Negotiated Rate	$136.51
Max. Negotiated Rate	$462.01
Rate for Payer: Aetna Commercial	$290.53
Rate for Payer: Aetna Medicare	$170.90
Rate for Payer: Aetna New Business (MI Preferred)	$222.17
Rate for Payer: BCBS Complete	$136.72
Rate for Payer: BCBS Trust/PPO	$462.01
Rate for Payer: BCN Commercial	$462.01
Rate for Payer: Cash Price	$273.44
Rate for Payer: Cash Price	$273.44
Rate for Payer: Cofinity Commercial	$293.95
Rate for Payer: Cofinity Commercial	$239.26
Rate for Payer: Cofinity Medicare Advantage	$239.26
Rate for Payer: Encore Health Key Benefits Commercial	$273.44
Rate for Payer: Healthscope Commercial	$307.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$290.53
Rate for Payer: PHP Commercial	$290.53
Rate for Payer: Priority Health Cigna Priority Health	$222.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$170.64
Rate for Payer: Priority Health Narrow Network	$136.51
Rate for Payer: Priority Health SBD	$215.33

HC BRACE BK PROSTH SOCK MULTI-PLY/6

Facility

$302.02

Service Code	HCPCS L8420
Hospital Charge Code	27400024
Hospital Revenue Code	274
Min. Negotiated Rate	$20.14
Max. Negotiated Rate	$271.82
Rate for Payer: Aetna Commercial	$256.72
Rate for Payer: Aetna Medicare	$151.01
Rate for Payer: Aetna New Business (MI Preferred)	$196.31
Rate for Payer: BCBS Complete	$120.81
Rate for Payer: BCBS Trust/PPO	$68.18
Rate for Payer: BCN Commercial	$68.18
Rate for Payer: Cash Price	$241.62
Rate for Payer: Cash Price	$241.62
Rate for Payer: Cofinity Commercial	$259.74
Rate for Payer: Cofinity Commercial	$211.41
Rate for Payer: Cofinity Medicare Advantage	$211.41
Rate for Payer: Encore Health Key Benefits Commercial	$241.62
Rate for Payer: Healthscope Commercial	$271.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.72
Rate for Payer: PHP Commercial	$256.72
Rate for Payer: Priority Health Cigna Priority Health	$196.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.18
Rate for Payer: Priority Health Narrow Network	$20.14
Rate for Payer: Priority Health SBD	$190.27
Rate for Payer: UHC All Payor (Choice/PPO)	$29.51

HC BRACE BK PROSTH SOCK MULTI-PLY/6

Facility

$302.02

Service Code	HCPCS L8420
Hospital Charge Code	27400024
Hospital Revenue Code	274
Min. Negotiated Rate	$190.27
Max. Negotiated Rate	$271.82
Rate for Payer: Aetna Commercial	$256.72
Rate for Payer: Aetna New Business (MI Preferred)	$196.31
Rate for Payer: Cash Price	$241.62
Rate for Payer: Cofinity Commercial	$211.41
Rate for Payer: Cofinity Commercial	$259.74
Rate for Payer: Cofinity Medicare Advantage	$211.41
Rate for Payer: Encore Health Key Benefits Commercial	$241.62
Rate for Payer: Healthscope Commercial	$271.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.72
Rate for Payer: PHP Commercial	$256.72
Rate for Payer: Priority Health Cigna Priority Health	$196.31
Rate for Payer: Priority Health SBD	$190.27

HC BRACE BK PROSTH SOCK SINGLE-PLY/6

Facility

$96.05

Service Code	HCPCS L8470
Hospital Charge Code	27400032
Hospital Revenue Code	274
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$86.44
Rate for Payer: Aetna Commercial	$81.64
Rate for Payer: Aetna Medicare	$48.02
Rate for Payer: Aetna New Business (MI Preferred)	$62.43
Rate for Payer: BCBS Complete	$38.42
Rate for Payer: BCBS Trust/PPO	$21.68
Rate for Payer: BCN Commercial	$21.68
Rate for Payer: Cash Price	$76.84
Rate for Payer: Cash Price	$76.84
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Cofinity Commercial	$67.24
Rate for Payer: Cofinity Medicare Advantage	$67.24
Rate for Payer: Encore Health Key Benefits Commercial	$76.84
Rate for Payer: Healthscope Commercial	$86.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.64
Rate for Payer: PHP Commercial	$81.64
Rate for Payer: Priority Health Cigna Priority Health	$62.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.01
Rate for Payer: Priority Health Narrow Network	$6.41
Rate for Payer: Priority Health SBD	$60.51

HC BRACE BK PROSTH SOCK SINGLE-PLY/6

Facility

$96.05

Service Code	HCPCS L8470
Hospital Charge Code	27400032
Hospital Revenue Code	274
Min. Negotiated Rate	$60.51
Max. Negotiated Rate	$86.44
Rate for Payer: Aetna Commercial	$81.64
Rate for Payer: Aetna New Business (MI Preferred)	$62.43
Rate for Payer: Cash Price	$76.84
Rate for Payer: Cofinity Commercial	$67.24
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Cofinity Medicare Advantage	$67.24
Rate for Payer: Encore Health Key Benefits Commercial	$76.84
Rate for Payer: Healthscope Commercial	$86.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.64
Rate for Payer: PHP Commercial	$81.64
Rate for Payer: Priority Health Cigna Priority Health	$62.43
Rate for Payer: Priority Health SBD	$60.51

HC BRACE BK RIGID DRESSING NWB

Facility

$1,121.27

Service Code	HCPCS L5450
Hospital Charge Code	27000013
Hospital Revenue Code	274
Min. Negotiated Rate	$448.51
Max. Negotiated Rate	$1,545.81
Rate for Payer: Aetna Commercial	$953.08
Rate for Payer: Aetna Medicare	$560.64
Rate for Payer: Aetna New Business (MI Preferred)	$728.83
Rate for Payer: BCBS Complete	$448.51
Rate for Payer: BCBS Trust/PPO	$1,545.81
Rate for Payer: BCN Commercial	$1,545.81
Rate for Payer: Cash Price	$897.02
Rate for Payer: Cash Price	$897.02
Rate for Payer: Cofinity Commercial	$964.29
Rate for Payer: Cofinity Commercial	$784.89
Rate for Payer: Cofinity Medicare Advantage	$784.89
Rate for Payer: Encore Health Key Benefits Commercial	$897.02
Rate for Payer: Healthscope Commercial	$1,009.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$953.08
Rate for Payer: PHP Commercial	$953.08
Rate for Payer: Priority Health Cigna Priority Health	$728.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$570.93
Rate for Payer: Priority Health Narrow Network	$456.74
Rate for Payer: Priority Health SBD	$706.40

HC BRACE BK RIGID DRESSING NWB

Facility

$1,121.27

Service Code	HCPCS L5450
Hospital Charge Code	27000013
Hospital Revenue Code	274
Min. Negotiated Rate	$706.40
Max. Negotiated Rate	$1,009.14
Rate for Payer: Aetna Commercial	$953.08
Rate for Payer: Aetna New Business (MI Preferred)	$728.83
Rate for Payer: Cash Price	$897.02
Rate for Payer: Cofinity Commercial	$784.89
Rate for Payer: Cofinity Commercial	$964.29
Rate for Payer: Cofinity Medicare Advantage	$784.89
Rate for Payer: Encore Health Key Benefits Commercial	$897.02
Rate for Payer: Healthscope Commercial	$1,009.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$953.08
Rate for Payer: PHP Commercial	$953.08
Rate for Payer: Priority Health Cigna Priority Health	$728.83
Rate for Payer: Priority Health SBD	$706.40

HC BRACE CERVICAL COLLAR CUSTOM

Facility

$1,259.02

Service Code	HCPCS L0190
Hospital Charge Code	27000014
Hospital Revenue Code	274
Min. Negotiated Rate	$793.18
Max. Negotiated Rate	$1,133.12
Rate for Payer: Aetna Commercial	$1,070.17
Rate for Payer: Aetna New Business (MI Preferred)	$818.36
Rate for Payer: Cash Price	$1,007.22
Rate for Payer: Cofinity Commercial	$1,082.76
Rate for Payer: Cofinity Commercial	$881.31
Rate for Payer: Cofinity Medicare Advantage	$881.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.22
Rate for Payer: Healthscope Commercial	$1,133.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.17
Rate for Payer: PHP Commercial	$1,070.17
Rate for Payer: Priority Health Cigna Priority Health	$818.36
Rate for Payer: Priority Health SBD	$793.18

HC BRACE CERVICAL COLLAR CUSTOM

Facility

$1,259.02

Service Code	HCPCS L0190
Hospital Charge Code	27000014
Hospital Revenue Code	274
Min. Negotiated Rate	$503.61
Max. Negotiated Rate	$1,735.78
Rate for Payer: Aetna Commercial	$1,070.17
Rate for Payer: Aetna Medicare	$629.51
Rate for Payer: Aetna New Business (MI Preferred)	$818.36
Rate for Payer: BCBS Complete	$503.61
Rate for Payer: BCBS Trust/PPO	$1,735.78
Rate for Payer: BCN Commercial	$1,735.78
Rate for Payer: Cash Price	$1,007.22
Rate for Payer: Cash Price	$1,007.22
Rate for Payer: Cofinity Commercial	$1,082.76
Rate for Payer: Cofinity Commercial	$881.31
Rate for Payer: Cofinity Medicare Advantage	$881.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.22
Rate for Payer: Healthscope Commercial	$1,133.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.17
Rate for Payer: PHP Commercial	$1,070.17
Rate for Payer: Priority Health Cigna Priority Health	$818.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$641.10
Rate for Payer: Priority Health Narrow Network	$512.88
Rate for Payer: Priority Health SBD	$793.18
Rate for Payer: UHC All Payor (Choice/PPO)	$751.28

HC BRACE CERVICAL THORA EXTENSION

Facility

$1,071.00

Service Code	HCPCS L1499
Hospital Charge Code	27400030
Hospital Revenue Code	274
Min. Negotiated Rate	$674.73
Max. Negotiated Rate	$963.90
Rate for Payer: Aetna Commercial	$910.35
Rate for Payer: Aetna New Business (MI Preferred)	$696.15
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$749.70
Rate for Payer: Cofinity Commercial	$921.06
Rate for Payer: Cofinity Medicare Advantage	$749.70
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: PHP Commercial	$910.35
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health SBD	$674.73

HC BRACE CERVICAL THORA EXTENSION

Facility

$1,071.00

Service Code	HCPCS L1499
Hospital Charge Code	27400030
Hospital Revenue Code	274
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$1,315.19
Rate for Payer: Aetna Commercial	$910.35
Rate for Payer: Aetna Medicare	$535.50
Rate for Payer: Aetna New Business (MI Preferred)	$696.15
Rate for Payer: BCBS Complete	$428.40
Rate for Payer: BCBS Trust/PPO	$1,315.19
Rate for Payer: BCN Commercial	$1,315.19
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$749.70
Rate for Payer: Cofinity Commercial	$921.06
Rate for Payer: Cofinity Medicare Advantage	$749.70
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: PHP Commercial	$910.35
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health SBD	$674.73

HC BRACE CTLSO CUSTOM

Facility

$5,882.73

Hospital Charge Code	27000032
Hospital Revenue Code	274
Min. Negotiated Rate	$2,353.09
Max. Negotiated Rate	$5,294.46
Rate for Payer: Aetna Commercial	$5,000.32
Rate for Payer: Aetna Medicare	$2,941.36
Rate for Payer: Aetna New Business (MI Preferred)	$3,823.77
Rate for Payer: BCBS Complete	$2,353.09
Rate for Payer: Cash Price	$4,706.18
Rate for Payer: Cofinity Commercial	$4,117.91
Rate for Payer: Cofinity Commercial	$5,059.15
Rate for Payer: Cofinity Medicare Advantage	$4,117.91
Rate for Payer: Encore Health Key Benefits Commercial	$4,706.18
Rate for Payer: Healthscope Commercial	$5,294.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.32
Rate for Payer: PHP Commercial	$5,000.32
Rate for Payer: Priority Health Cigna Priority Health	$3,823.77
Rate for Payer: Priority Health SBD	$3,706.12

HC BRACE CTLSO CUSTOM

Facility

$5,882.73

Hospital Charge Code	27000032
Hospital Revenue Code	274
Min. Negotiated Rate	$3,706.12
Max. Negotiated Rate	$5,294.46
Rate for Payer: Aetna Commercial	$5,000.32
Rate for Payer: Aetna New Business (MI Preferred)	$3,823.77
Rate for Payer: Cash Price	$4,706.18
Rate for Payer: Cofinity Commercial	$4,117.91
Rate for Payer: Cofinity Commercial	$5,059.15
Rate for Payer: Cofinity Medicare Advantage	$4,117.91
Rate for Payer: Encore Health Key Benefits Commercial	$4,706.18
Rate for Payer: Healthscope Commercial	$5,294.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.32
Rate for Payer: PHP Commercial	$5,000.32
Rate for Payer: Priority Health Cigna Priority Health	$3,823.77
Rate for Payer: Priority Health SBD	$3,706.12

HC BRACE CTO

Facility

$1,482.06

Service Code	HCPCS L0200
Hospital Charge Code	27400029
Hospital Revenue Code	274
Min. Negotiated Rate	$933.70
Max. Negotiated Rate	$1,333.85
Rate for Payer: Aetna Commercial	$1,259.75
Rate for Payer: Aetna New Business (MI Preferred)	$963.34
Rate for Payer: Cash Price	$1,185.65
Rate for Payer: Cofinity Commercial	$1,037.44
Rate for Payer: Cofinity Commercial	$1,274.57
Rate for Payer: Cofinity Medicare Advantage	$1,037.44
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.65
Rate for Payer: Healthscope Commercial	$1,333.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.75
Rate for Payer: PHP Commercial	$1,259.75
Rate for Payer: Priority Health Cigna Priority Health	$963.34
Rate for Payer: Priority Health SBD	$933.70

HC BRACE CTO

Facility

$1,482.06

Service Code	HCPCS L0200
Hospital Charge Code	27400029
Hospital Revenue Code	274
Min. Negotiated Rate	$592.82
Max. Negotiated Rate	$2,013.36
Rate for Payer: Aetna Commercial	$1,259.75
Rate for Payer: Aetna Medicare	$741.03
Rate for Payer: Aetna New Business (MI Preferred)	$963.34
Rate for Payer: BCBS Complete	$592.82
Rate for Payer: BCBS Trust/PPO	$2,013.36
Rate for Payer: BCN Commercial	$2,013.36
Rate for Payer: Cash Price	$1,185.65
Rate for Payer: Cash Price	$1,185.65
Rate for Payer: Cofinity Commercial	$1,274.57
Rate for Payer: Cofinity Commercial	$1,037.44
Rate for Payer: Cofinity Medicare Advantage	$1,037.44
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.65
Rate for Payer: Healthscope Commercial	$1,333.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.75
Rate for Payer: PHP Commercial	$1,259.75
Rate for Payer: Priority Health Cigna Priority Health	$963.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$743.62
Rate for Payer: Priority Health Narrow Network	$594.90
Rate for Payer: Priority Health SBD	$933.70

HC BRACE CTO REPLACEMENT PADS

Facility

$275.40

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$1,315.19
Rate for Payer: Aetna Commercial	$234.09
Rate for Payer: Aetna Medicare	$137.70
Rate for Payer: Aetna New Business (MI Preferred)	$179.01
Rate for Payer: BCBS Complete	$110.16
Rate for Payer: BCBS Trust/PPO	$1,315.19
Rate for Payer: BCN Commercial	$1,315.19
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$192.78
Rate for Payer: Cofinity Commercial	$236.84
Rate for Payer: Cofinity Medicare Advantage	$192.78
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: PHP Commercial	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health SBD	$173.50

HC BRACE CTO REPLACEMENT PADS

Facility

$275.40

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$173.50
Max. Negotiated Rate	$247.86
Rate for Payer: Aetna Commercial	$234.09
Rate for Payer: Aetna New Business (MI Preferred)	$179.01
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$192.78
Rate for Payer: Cofinity Commercial	$236.84
Rate for Payer: Cofinity Medicare Advantage	$192.78
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: PHP Commercial	$234.09
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health SBD	$173.50

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$63.34
Rate for Payer: Aetna Commercial	$59.82
Rate for Payer: Aetna New Business (MI Preferred)	$45.75
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$49.27
Rate for Payer: Cofinity Commercial	$60.53
Rate for Payer: Cofinity Medicare Advantage	$49.27
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: PHP Commercial	$59.82
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: Priority Health SBD	$44.34

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$217.67
Rate for Payer: Aetna Commercial	$59.82
Rate for Payer: Aetna Medicare	$35.19
Rate for Payer: Aetna New Business (MI Preferred)	$45.75
Rate for Payer: BCBS Complete	$28.15
Rate for Payer: BCBS Trust/PPO	$217.67
Rate for Payer: BCN Commercial	$217.67
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$60.53
Rate for Payer: Cofinity Commercial	$49.27
Rate for Payer: Cofinity Medicare Advantage	$49.27
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: PHP Commercial	$59.82
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.39
Rate for Payer: Priority Health Narrow Network	$64.31
Rate for Payer: Priority Health SBD	$44.34
Rate for Payer: UHC All Payor (Choice/PPO)	$94.21

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$430.78
Max. Negotiated Rate	$1,484.78
Rate for Payer: Aetna Commercial	$915.41
Rate for Payer: Aetna Medicare	$538.48
Rate for Payer: Aetna New Business (MI Preferred)	$700.02
Rate for Payer: BCBS Complete	$430.78
Rate for Payer: BCBS Trust/PPO	$1,484.78
Rate for Payer: BCN Commercial	$1,484.78
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$926.18
Rate for Payer: Cofinity Commercial	$753.86
Rate for Payer: Cofinity Medicare Advantage	$753.86
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$969.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: PHP Commercial	$915.41
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$548.39
Rate for Payer: Priority Health Narrow Network	$438.71
Rate for Payer: Priority Health SBD	$678.48

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$678.48
Max. Negotiated Rate	$969.26
Rate for Payer: Aetna Commercial	$915.41
Rate for Payer: Aetna New Business (MI Preferred)	$700.02
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$753.86
Rate for Payer: Cofinity Commercial	$926.18
Rate for Payer: Cofinity Medicare Advantage	$753.86
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$969.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: PHP Commercial	$915.41
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: Priority Health SBD	$678.48

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

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$279.48
Max. Negotiated Rate	$2,221.74
Rate for Payer: Aetna Commercial	$593.90
Rate for Payer: Aetna Medicare	$349.35
Rate for Payer: Aetna New Business (MI Preferred)	$454.16
Rate for Payer: BCBS Complete	$279.48
Rate for Payer: BCBS Trust/PPO	$2,221.74
Rate for Payer: BCN Commercial	$2,221.74
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$600.88
Rate for Payer: Cofinity Commercial	$489.09
Rate for Payer: Cofinity Medicare Advantage	$489.09
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.90
Rate for Payer: PHP Commercial	$593.90
Rate for Payer: Priority Health Cigna Priority Health	$454.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$820.58
Rate for Payer: Priority Health Narrow Network	$656.46
Rate for Payer: Priority Health SBD	$440.18

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

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$440.18
Max. Negotiated Rate	$628.83
Rate for Payer: Aetna Commercial	$593.90
Rate for Payer: Aetna New Business (MI Preferred)	$454.16
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$489.09
Rate for Payer: Cofinity Commercial	$600.88
Rate for Payer: Cofinity Medicare Advantage	$489.09
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.90
Rate for Payer: PHP Commercial	$593.90
Rate for Payer: Priority Health Cigna Priority Health	$454.16
Rate for Payer: Priority Health SBD	$440.18

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$36.72
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health SBD	$25.70

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$67.37
Rate for Payer: Aetna Commercial	$34.68
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$26.52
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$35.09
Rate for Payer: Cofinity Commercial	$28.56
Rate for Payer: Cofinity Medicare Advantage	$28.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: PHP Commercial	$34.68
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.37
Rate for Payer: Priority Health Narrow Network	$53.90
Rate for Payer: Priority Health SBD	$25.70

Know your out-of-pocket cost for care.

All Charges