Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE HFO W/O JOINTS CF

Facility

$258.02

Service Code	HCPCS L3913
Hospital Charge Code	27400042
Hospital Revenue Code	274
Min. Negotiated Rate	$103.21
Max. Negotiated Rate	$232.22
Rate for Payer: Aetna Commercial	$219.32
Rate for Payer: Aetna Medicare	$129.01
Rate for Payer: Aetna New Business (MI Preferred)	$167.71
Rate for Payer: BCBS Complete	$103.21
Rate for Payer: Cash Price	$206.42
Rate for Payer: Cofinity Commercial	$180.61
Rate for Payer: Cofinity Commercial	$221.90
Rate for Payer: Cofinity Medicare Advantage	$180.61
Rate for Payer: Encore Health Key Benefits Commercial	$206.42
Rate for Payer: Healthscope Commercial	$232.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.32
Rate for Payer: PHP Commercial	$219.32
Rate for Payer: Priority Health Cigna Priority Health	$167.71
Rate for Payer: Priority Health SBD	$162.55

HC BRACE HFO W/O JOINTS CF

Facility

$258.02

Service Code	HCPCS L3913
Hospital Charge Code	27400042
Hospital Revenue Code	274
Min. Negotiated Rate	$162.55
Max. Negotiated Rate	$232.22
Rate for Payer: Aetna Commercial	$219.32
Rate for Payer: Aetna New Business (MI Preferred)	$167.71
Rate for Payer: Cash Price	$206.42
Rate for Payer: Cofinity Commercial	$180.61
Rate for Payer: Cofinity Commercial	$221.90
Rate for Payer: Cofinity Medicare Advantage	$180.61
Rate for Payer: Encore Health Key Benefits Commercial	$206.42
Rate for Payer: Healthscope Commercial	$232.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.32
Rate for Payer: PHP Commercial	$219.32
Rate for Payer: Priority Health Cigna Priority Health	$167.71
Rate for Payer: Priority Health SBD	$162.55

HC BRACE HIP ABDUCTION

Facility

$1,847.67

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$739.07
Max. Negotiated Rate	$1,662.90
Rate for Payer: Aetna Commercial	$1,570.52
Rate for Payer: Aetna Medicare	$923.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,200.99
Rate for Payer: BCBS Complete	$739.07
Rate for Payer: Cash Price	$1,478.14
Rate for Payer: Cofinity Commercial	$1,293.37
Rate for Payer: Cofinity Commercial	$1,589.00
Rate for Payer: Cofinity Medicare Advantage	$1,293.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,478.14
Rate for Payer: Healthscope Commercial	$1,662.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,570.52
Rate for Payer: PHP Commercial	$1,570.52
Rate for Payer: Priority Health Cigna Priority Health	$1,200.99
Rate for Payer: Priority Health SBD	$1,164.03

HC BRACE HIP ABDUCTION

Facility

$1,847.67

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$1,164.03
Max. Negotiated Rate	$1,662.90
Rate for Payer: Aetna Commercial	$1,570.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,200.99
Rate for Payer: Cash Price	$1,478.14
Rate for Payer: Cofinity Commercial	$1,293.37
Rate for Payer: Cofinity Commercial	$1,589.00
Rate for Payer: Cofinity Medicare Advantage	$1,293.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,478.14
Rate for Payer: Healthscope Commercial	$1,662.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,570.52
Rate for Payer: PHP Commercial	$1,570.52
Rate for Payer: Priority Health Cigna Priority Health	$1,200.99
Rate for Payer: Priority Health SBD	$1,164.03

HC BRACE HUMERAL SLEEVE

Facility

$833.07

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$333.23
Max. Negotiated Rate	$749.76
Rate for Payer: Aetna Commercial	$708.11
Rate for Payer: Aetna Medicare	$416.54
Rate for Payer: Aetna New Business (MI Preferred)	$541.50
Rate for Payer: BCBS Complete	$333.23
Rate for Payer: Cash Price	$666.46
Rate for Payer: Cofinity Commercial	$583.15
Rate for Payer: Cofinity Commercial	$716.44
Rate for Payer: Cofinity Medicare Advantage	$583.15
Rate for Payer: Encore Health Key Benefits Commercial	$666.46
Rate for Payer: Healthscope Commercial	$749.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$708.11
Rate for Payer: PHP Commercial	$708.11
Rate for Payer: Priority Health Cigna Priority Health	$541.50
Rate for Payer: Priority Health SBD	$524.83

HC BRACE HUMERAL SLEEVE

Facility

$833.07

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$524.83
Max. Negotiated Rate	$749.76
Rate for Payer: Aetna Commercial	$708.11
Rate for Payer: Aetna New Business (MI Preferred)	$541.50
Rate for Payer: Cash Price	$666.46
Rate for Payer: Cofinity Commercial	$583.15
Rate for Payer: Cofinity Commercial	$716.44
Rate for Payer: Cofinity Medicare Advantage	$583.15
Rate for Payer: Encore Health Key Benefits Commercial	$666.46
Rate for Payer: Healthscope Commercial	$749.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$708.11
Rate for Payer: PHP Commercial	$708.11
Rate for Payer: Priority Health Cigna Priority Health	$541.50
Rate for Payer: Priority Health SBD	$524.83

HC BRACE JEWETT/CASH

Facility

$957.96

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$603.51
Max. Negotiated Rate	$862.16
Rate for Payer: Aetna Commercial	$814.27
Rate for Payer: Aetna New Business (MI Preferred)	$622.67
Rate for Payer: Cash Price	$766.37
Rate for Payer: Cofinity Commercial	$670.57
Rate for Payer: Cofinity Commercial	$823.85
Rate for Payer: Cofinity Medicare Advantage	$670.57
Rate for Payer: Encore Health Key Benefits Commercial	$766.37
Rate for Payer: Healthscope Commercial	$862.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.27
Rate for Payer: PHP Commercial	$814.27
Rate for Payer: Priority Health Cigna Priority Health	$622.67
Rate for Payer: Priority Health SBD	$603.51

HC BRACE JEWETT/CASH

Facility

$957.96

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$383.18
Max. Negotiated Rate	$862.16
Rate for Payer: Aetna Commercial	$814.27
Rate for Payer: Aetna Medicare	$478.98
Rate for Payer: Aetna New Business (MI Preferred)	$622.67
Rate for Payer: BCBS Complete	$383.18
Rate for Payer: Cash Price	$766.37
Rate for Payer: Cofinity Commercial	$670.57
Rate for Payer: Cofinity Commercial	$823.85
Rate for Payer: Cofinity Medicare Advantage	$670.57
Rate for Payer: Encore Health Key Benefits Commercial	$766.37
Rate for Payer: Healthscope Commercial	$862.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$814.27
Rate for Payer: PHP Commercial	$814.27
Rate for Payer: Priority Health Cigna Priority Health	$622.67
Rate for Payer: Priority Health SBD	$603.51

HC BRACE KAFO CUSTOM

Facility

$4,971.02

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$3,131.74
Max. Negotiated Rate	$4,473.92
Rate for Payer: Aetna Commercial	$4,225.37
Rate for Payer: Aetna New Business (MI Preferred)	$3,231.16
Rate for Payer: Cash Price	$3,976.82
Rate for Payer: Cofinity Commercial	$3,479.71
Rate for Payer: Cofinity Commercial	$4,275.08
Rate for Payer: Cofinity Medicare Advantage	$3,479.71
Rate for Payer: Encore Health Key Benefits Commercial	$3,976.82
Rate for Payer: Healthscope Commercial	$4,473.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,225.37
Rate for Payer: PHP Commercial	$4,225.37
Rate for Payer: Priority Health Cigna Priority Health	$3,231.16
Rate for Payer: Priority Health SBD	$3,131.74

HC BRACE KAFO CUSTOM

Facility

$4,971.02

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$1,988.41
Max. Negotiated Rate	$4,473.92
Rate for Payer: Aetna Commercial	$4,225.37
Rate for Payer: Aetna Medicare	$2,485.51
Rate for Payer: Aetna New Business (MI Preferred)	$3,231.16
Rate for Payer: BCBS Complete	$1,988.41
Rate for Payer: Cash Price	$3,976.82
Rate for Payer: Cofinity Commercial	$3,479.71
Rate for Payer: Cofinity Commercial	$4,275.08
Rate for Payer: Cofinity Medicare Advantage	$3,479.71
Rate for Payer: Encore Health Key Benefits Commercial	$3,976.82
Rate for Payer: Healthscope Commercial	$4,473.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,225.37
Rate for Payer: PHP Commercial	$4,225.37
Rate for Payer: Priority Health Cigna Priority Health	$3,231.16
Rate for Payer: Priority Health SBD	$3,131.74

HC BRACE KNEE HINGED CUSTOM

Facility

$1,385.37

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$872.78
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$1,177.56
Rate for Payer: Aetna New Business (MI Preferred)	$900.49
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cofinity Commercial	$1,191.42
Rate for Payer: Cofinity Commercial	$969.76
Rate for Payer: Cofinity Medicare Advantage	$969.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,108.30
Rate for Payer: Healthscope Commercial	$1,246.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,177.56
Rate for Payer: PHP Commercial	$1,177.56
Rate for Payer: Priority Health Cigna Priority Health	$900.49
Rate for Payer: Priority Health SBD	$872.78

HC BRACE KNEE HINGED CUSTOM

Facility

$1,385.37

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$554.15
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$1,177.56
Rate for Payer: Aetna Medicare	$692.68
Rate for Payer: Aetna New Business (MI Preferred)	$900.49
Rate for Payer: BCBS Complete	$554.15
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cofinity Commercial	$1,191.42
Rate for Payer: Cofinity Commercial	$969.76
Rate for Payer: Cofinity Medicare Advantage	$969.76
Rate for Payer: Encore Health Key Benefits Commercial	$1,108.30
Rate for Payer: Healthscope Commercial	$1,246.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,177.56
Rate for Payer: PHP Commercial	$1,177.56
Rate for Payer: Priority Health Cigna Priority Health	$900.49
Rate for Payer: Priority Health SBD	$872.78

HC BRACE KNEE HINGED OTS

Facility

$1,629.86

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$1,026.81
Max. Negotiated Rate	$1,466.87
Rate for Payer: Aetna Commercial	$1,385.38
Rate for Payer: Aetna New Business (MI Preferred)	$1,059.41
Rate for Payer: Cash Price	$1,303.89
Rate for Payer: Cofinity Commercial	$1,140.90
Rate for Payer: Cofinity Commercial	$1,401.68
Rate for Payer: Cofinity Medicare Advantage	$1,140.90
Rate for Payer: Encore Health Key Benefits Commercial	$1,303.89
Rate for Payer: Healthscope Commercial	$1,466.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,385.38
Rate for Payer: PHP Commercial	$1,385.38
Rate for Payer: Priority Health Cigna Priority Health	$1,059.41
Rate for Payer: Priority Health SBD	$1,026.81

HC BRACE KNEE HINGED OTS

Facility

$1,629.86

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$651.94
Max. Negotiated Rate	$1,466.87
Rate for Payer: Aetna Commercial	$1,385.38
Rate for Payer: Aetna Medicare	$814.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,059.41
Rate for Payer: BCBS Complete	$651.94
Rate for Payer: Cash Price	$1,303.89
Rate for Payer: Cofinity Commercial	$1,140.90
Rate for Payer: Cofinity Commercial	$1,401.68
Rate for Payer: Cofinity Medicare Advantage	$1,140.90
Rate for Payer: Encore Health Key Benefits Commercial	$1,303.89
Rate for Payer: Healthscope Commercial	$1,466.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,385.38
Rate for Payer: PHP Commercial	$1,385.38
Rate for Payer: Priority Health Cigna Priority Health	$1,059.41
Rate for Payer: Priority Health SBD	$1,026.81

HC BRACE KNEE IMMOBILIZER

Facility

$202.83

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$81.13
Max. Negotiated Rate	$182.55
Rate for Payer: Aetna Commercial	$172.41
Rate for Payer: Aetna Medicare	$101.42
Rate for Payer: Aetna New Business (MI Preferred)	$131.84
Rate for Payer: BCBS Complete	$81.13
Rate for Payer: Cash Price	$162.26
Rate for Payer: Cofinity Commercial	$141.98
Rate for Payer: Cofinity Commercial	$174.43
Rate for Payer: Cofinity Medicare Advantage	$141.98
Rate for Payer: Encore Health Key Benefits Commercial	$162.26
Rate for Payer: Healthscope Commercial	$182.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.41
Rate for Payer: PHP Commercial	$172.41
Rate for Payer: Priority Health Cigna Priority Health	$131.84
Rate for Payer: Priority Health SBD	$127.78

HC BRACE KNEE IMMOBILIZER

Facility

$202.83

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$127.78
Max. Negotiated Rate	$182.55
Rate for Payer: Aetna Commercial	$172.41
Rate for Payer: Aetna New Business (MI Preferred)	$131.84
Rate for Payer: Cash Price	$162.26
Rate for Payer: Cofinity Commercial	$141.98
Rate for Payer: Cofinity Commercial	$174.43
Rate for Payer: Cofinity Medicare Advantage	$141.98
Rate for Payer: Encore Health Key Benefits Commercial	$162.26
Rate for Payer: Healthscope Commercial	$182.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.41
Rate for Payer: PHP Commercial	$172.41
Rate for Payer: Priority Health Cigna Priority Health	$131.84
Rate for Payer: Priority Health SBD	$127.78

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$651.78

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$260.71
Max. Negotiated Rate	$586.60
Rate for Payer: Aetna Commercial	$554.01
Rate for Payer: Aetna Medicare	$325.89
Rate for Payer: Aetna New Business (MI Preferred)	$423.66
Rate for Payer: BCBS Complete	$260.71
Rate for Payer: Cash Price	$521.42
Rate for Payer: Cofinity Commercial	$456.25
Rate for Payer: Cofinity Commercial	$560.53
Rate for Payer: Cofinity Medicare Advantage	$456.25
Rate for Payer: Encore Health Key Benefits Commercial	$521.42
Rate for Payer: Healthscope Commercial	$586.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$554.01
Rate for Payer: PHP Commercial	$554.01
Rate for Payer: Priority Health Cigna Priority Health	$423.66
Rate for Payer: Priority Health SBD	$410.62

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$651.78

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$410.62
Max. Negotiated Rate	$586.60
Rate for Payer: Aetna Commercial	$554.01
Rate for Payer: Aetna New Business (MI Preferred)	$423.66
Rate for Payer: Cash Price	$521.42
Rate for Payer: Cofinity Commercial	$456.25
Rate for Payer: Cofinity Commercial	$560.53
Rate for Payer: Cofinity Medicare Advantage	$456.25
Rate for Payer: Encore Health Key Benefits Commercial	$521.42
Rate for Payer: Healthscope Commercial	$586.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$554.01
Rate for Payer: PHP Commercial	$554.01
Rate for Payer: Priority Health Cigna Priority Health	$423.66
Rate for Payer: Priority Health SBD	$410.62

HC BRACE LS CORSET CUSTOM

Facility

$185.64

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$116.95
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Commercial	$157.79
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: Cash Price	$148.51
Rate for Payer: Cofinity Commercial	$129.95
Rate for Payer: Cofinity Commercial	$159.65
Rate for Payer: Cofinity Medicare Advantage	$129.95
Rate for Payer: Encore Health Key Benefits Commercial	$148.51
Rate for Payer: Healthscope Commercial	$167.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.79
Rate for Payer: PHP Commercial	$157.79
Rate for Payer: Priority Health Cigna Priority Health	$120.67
Rate for Payer: Priority Health SBD	$116.95

HC BRACE LS CORSET CUSTOM

Facility

$185.64

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$74.26
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Commercial	$157.79
Rate for Payer: Aetna Medicare	$92.82
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: Cash Price	$148.51
Rate for Payer: Cofinity Commercial	$129.95
Rate for Payer: Cofinity Commercial	$159.65
Rate for Payer: Cofinity Medicare Advantage	$129.95
Rate for Payer: Encore Health Key Benefits Commercial	$148.51
Rate for Payer: Healthscope Commercial	$167.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.79
Rate for Payer: PHP Commercial	$157.79
Rate for Payer: Priority Health Cigna Priority Health	$120.67
Rate for Payer: Priority Health SBD	$116.95

HC BRACE LS CORSET OTS

Facility

$194.92

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$175.43
Rate for Payer: Aetna Commercial	$165.68
Rate for Payer: Aetna Medicare	$97.46
Rate for Payer: Aetna New Business (MI Preferred)	$126.70
Rate for Payer: BCBS Complete	$77.97
Rate for Payer: Cash Price	$155.94
Rate for Payer: Cofinity Commercial	$136.44
Rate for Payer: Cofinity Commercial	$167.63
Rate for Payer: Cofinity Medicare Advantage	$136.44
Rate for Payer: Encore Health Key Benefits Commercial	$155.94
Rate for Payer: Healthscope Commercial	$175.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.68
Rate for Payer: PHP Commercial	$165.68
Rate for Payer: Priority Health Cigna Priority Health	$126.70
Rate for Payer: Priority Health SBD	$122.80

HC BRACE LS CORSET OTS

Facility

$194.92

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$122.80
Max. Negotiated Rate	$175.43
Rate for Payer: Aetna Commercial	$165.68
Rate for Payer: Aetna New Business (MI Preferred)	$126.70
Rate for Payer: Cash Price	$155.94
Rate for Payer: Cofinity Commercial	$136.44
Rate for Payer: Cofinity Commercial	$167.63
Rate for Payer: Cofinity Medicare Advantage	$136.44
Rate for Payer: Encore Health Key Benefits Commercial	$155.94
Rate for Payer: Healthscope Commercial	$175.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.68
Rate for Payer: PHP Commercial	$165.68
Rate for Payer: Priority Health Cigna Priority Health	$126.70
Rate for Payer: Priority Health SBD	$122.80

HC BRACE LSO CUSTOM

Facility

$2,554.51

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,021.80
Max. Negotiated Rate	$2,299.06
Rate for Payer: Aetna Commercial	$2,171.33
Rate for Payer: Aetna Medicare	$1,277.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,660.43
Rate for Payer: BCBS Complete	$1,021.80
Rate for Payer: Cash Price	$2,043.61
Rate for Payer: Cofinity Commercial	$1,788.16
Rate for Payer: Cofinity Commercial	$2,196.88
Rate for Payer: Cofinity Medicare Advantage	$1,788.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,043.61
Rate for Payer: Healthscope Commercial	$2,299.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,171.33
Rate for Payer: PHP Commercial	$2,171.33
Rate for Payer: Priority Health Cigna Priority Health	$1,660.43
Rate for Payer: Priority Health SBD	$1,609.34

HC BRACE LSO CUSTOM

Facility

$2,554.51

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,609.34
Max. Negotiated Rate	$2,299.06
Rate for Payer: Aetna Commercial	$2,171.33
Rate for Payer: Aetna New Business (MI Preferred)	$1,660.43
Rate for Payer: Cash Price	$2,043.61
Rate for Payer: Cofinity Commercial	$1,788.16
Rate for Payer: Cofinity Commercial	$2,196.88
Rate for Payer: Cofinity Medicare Advantage	$1,788.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,043.61
Rate for Payer: Healthscope Commercial	$2,299.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,171.33
Rate for Payer: PHP Commercial	$2,171.33
Rate for Payer: Priority Health Cigna Priority Health	$1,660.43
Rate for Payer: Priority Health SBD	$1,609.34

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,719.28

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,713.15
Max. Negotiated Rate	$2,447.35
Rate for Payer: Aetna Commercial	$2,311.39
Rate for Payer: Aetna New Business (MI Preferred)	$1,767.53
Rate for Payer: Cash Price	$2,175.42
Rate for Payer: Cofinity Commercial	$1,903.50
Rate for Payer: Cofinity Commercial	$2,338.58
Rate for Payer: Cofinity Medicare Advantage	$1,903.50
Rate for Payer: Encore Health Key Benefits Commercial	$2,175.42
Rate for Payer: Healthscope Commercial	$2,447.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,311.39
Rate for Payer: PHP Commercial	$2,311.39
Rate for Payer: Priority Health Cigna Priority Health	$1,767.53
Rate for Payer: Priority Health SBD	$1,713.15

Know your out-of-pocket cost for care.

All Charges