Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$179.93
Rate for Payer: Aetna Commercial	$169.93
Rate for Payer: Aetna New Business (MI Preferred)	$129.95
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$139.94
Rate for Payer: Cofinity Commercial	$171.93
Rate for Payer: Cofinity Medicare Advantage	$139.94
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: PHP Commercial	$169.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: Priority Health SBD	$125.95

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$79.97
Max. Negotiated Rate	$633.46
Rate for Payer: Aetna Commercial	$169.93
Rate for Payer: Aetna Medicare	$99.96
Rate for Payer: Aetna New Business (MI Preferred)	$129.95
Rate for Payer: BCBS Complete	$79.97
Rate for Payer: BCBS Trust/PPO	$633.46
Rate for Payer: BCN Commercial	$633.46
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$171.93
Rate for Payer: Cofinity Commercial	$139.94
Rate for Payer: Cofinity Medicare Advantage	$139.94
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: PHP Commercial	$169.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$233.96
Rate for Payer: Priority Health Narrow Network	$187.17
Rate for Payer: Priority Health SBD	$125.95
Rate for Payer: UHC All Payor (Choice/PPO)	$274.18

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$266.28
Max. Negotiated Rate	$380.39
Rate for Payer: Aetna Commercial	$359.26
Rate for Payer: Aetna New Business (MI Preferred)	$274.73
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$295.86
Rate for Payer: Cofinity Commercial	$363.49
Rate for Payer: Cofinity Medicare Advantage	$295.86
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: PHP Commercial	$359.26
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: Priority Health SBD	$266.28

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$152.83
Max. Negotiated Rate	$517.24
Rate for Payer: Aetna Commercial	$359.26
Rate for Payer: Aetna Medicare	$211.33
Rate for Payer: Aetna New Business (MI Preferred)	$274.73
Rate for Payer: BCBS Complete	$169.06
Rate for Payer: BCBS Trust/PPO	$517.24
Rate for Payer: BCN Commercial	$517.24
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$363.49
Rate for Payer: Cofinity Commercial	$295.86
Rate for Payer: Cofinity Medicare Advantage	$295.86
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: PHP Commercial	$359.26
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$191.04
Rate for Payer: Priority Health Narrow Network	$152.83
Rate for Payer: Priority Health SBD	$266.28

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$319.52
Max. Negotiated Rate	$456.46
Rate for Payer: Aetna Commercial	$431.10
Rate for Payer: Aetna New Business (MI Preferred)	$329.67
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$355.03
Rate for Payer: Cofinity Commercial	$436.17
Rate for Payer: Cofinity Medicare Advantage	$355.03
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: PHP Commercial	$431.10
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: Priority Health SBD	$319.52

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$152.83
Max. Negotiated Rate	$517.24
Rate for Payer: Aetna Commercial	$431.10
Rate for Payer: Aetna Medicare	$253.59
Rate for Payer: Aetna New Business (MI Preferred)	$329.67
Rate for Payer: BCBS Complete	$202.87
Rate for Payer: BCBS Trust/PPO	$517.24
Rate for Payer: BCN Commercial	$517.24
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$436.17
Rate for Payer: Cofinity Commercial	$355.03
Rate for Payer: Cofinity Medicare Advantage	$355.03
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: PHP Commercial	$431.10
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$191.04
Rate for Payer: Priority Health Narrow Network	$152.83
Rate for Payer: Priority Health SBD	$319.52

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$188.92
Max. Negotiated Rate	$269.89
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna New Business (MI Preferred)	$194.92
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$209.92
Rate for Payer: Cofinity Commercial	$257.90
Rate for Payer: Cofinity Medicare Advantage	$209.92
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: PHP Commercial	$254.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: Priority Health SBD	$188.92

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$119.95
Max. Negotiated Rate	$953.68
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna Medicare	$149.94
Rate for Payer: Aetna New Business (MI Preferred)	$194.92
Rate for Payer: BCBS Complete	$119.95
Rate for Payer: BCBS Trust/PPO	$953.68
Rate for Payer: BCN Commercial	$953.68
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$209.92
Rate for Payer: Cofinity Commercial	$257.90
Rate for Payer: Cofinity Medicare Advantage	$209.92
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: PHP Commercial	$254.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$352.24
Rate for Payer: Priority Health Narrow Network	$281.79
Rate for Payer: Priority Health SBD	$188.92
Rate for Payer: UHC All Payor (Choice/PPO)	$412.78

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$323.79
Max. Negotiated Rate	$462.56
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna New Business (MI Preferred)	$334.07
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$359.77
Rate for Payer: Cofinity Commercial	$442.01
Rate for Payer: Cofinity Medicare Advantage	$359.77
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: PHP Commercial	$436.87
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: Priority Health SBD	$323.79

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$205.58
Max. Negotiated Rate	$804.02
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare	$256.98
Rate for Payer: Aetna New Business (MI Preferred)	$334.07
Rate for Payer: BCBS Complete	$205.58
Rate for Payer: BCBS Trust/PPO	$804.02
Rate for Payer: BCN Commercial	$804.02
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$442.01
Rate for Payer: Cofinity Commercial	$359.77
Rate for Payer: Cofinity Medicare Advantage	$359.77
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: PHP Commercial	$436.87
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$296.96
Rate for Payer: Priority Health Narrow Network	$237.57
Rate for Payer: Priority Health SBD	$323.79

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$168.32
Max. Negotiated Rate	$378.71
Rate for Payer: Aetna Commercial	$357.67
Rate for Payer: Aetna Medicare	$210.40
Rate for Payer: Aetna New Business (MI Preferred)	$273.51
Rate for Payer: BCBS Complete	$168.32
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$361.88
Rate for Payer: Cofinity Commercial	$294.55
Rate for Payer: Cofinity Medicare Advantage	$294.55
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: PHP Commercial	$357.67
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.28
Rate for Payer: Priority Health Narrow Network	$171.42
Rate for Payer: Priority Health SBD	$265.10

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$378.71
Rate for Payer: Aetna Commercial	$357.67
Rate for Payer: Aetna New Business (MI Preferred)	$273.51
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$294.55
Rate for Payer: Cofinity Commercial	$361.88
Rate for Payer: Cofinity Medicare Advantage	$294.55
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: PHP Commercial	$357.67
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: Priority Health SBD	$265.10

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$166.35
Rate for Payer: Aetna Commercial	$156.06
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: Aetna New Business (MI Preferred)	$119.34
Rate for Payer: BCBS Complete	$73.44
Rate for Payer: BCBS Trust/PPO	$166.35
Rate for Payer: BCN Commercial	$166.35
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$128.52
Rate for Payer: Cofinity Commercial	$157.90
Rate for Payer: Cofinity Medicare Advantage	$128.52
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: PHP Commercial	$156.06
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: Priority Health SBD	$115.67

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$115.67
Max. Negotiated Rate	$165.24
Rate for Payer: Aetna Commercial	$156.06
Rate for Payer: Aetna New Business (MI Preferred)	$119.34
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$128.52
Rate for Payer: Cofinity Commercial	$157.90
Rate for Payer: Cofinity Medicare Advantage	$128.52
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: PHP Commercial	$156.06
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: Priority Health SBD	$115.67

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$271.18
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna Medicare	$63.75
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: BCBS Complete	$51.00
Rate for Payer: BCBS Trust/PPO	$271.18
Rate for Payer: BCN Commercial	$271.18
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.16
Rate for Payer: Priority Health Narrow Network	$80.13
Rate for Payer: Priority Health SBD	$80.32

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$80.32
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$108.38
Rate for Payer: Aetna New Business (MI Preferred)	$82.88
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$109.65
Rate for Payer: Cofinity Commercial	$89.25
Rate for Payer: Cofinity Medicare Advantage	$89.25
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: PHP Commercial	$108.38
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health SBD	$80.32

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	$804.02
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: BCBS Trust/PPO	$804.02
Rate for Payer: BCN Commercial	$804.02
Rate for Payer: Cash Price	$206.42
Rate for Payer: Cash Price	$206.42
Rate for Payer: Cofinity Commercial	$221.90
Rate for Payer: Cofinity Commercial	$180.61
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 HMO/PPO/Tiered Network	$296.96
Rate for Payer: Priority Health Narrow Network	$237.57
Rate for Payer: Priority Health SBD	$162.55
Rate for Payer: UHC All Payor (Choice/PPO)	$348.00

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	$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 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	$3,056.74
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: BCBS Trust/PPO	$3,056.74
Rate for Payer: BCN Commercial	$3,056.74
Rate for Payer: Cash Price	$1,478.14
Rate for Payer: Cash Price	$1,478.14
Rate for Payer: Cofinity Commercial	$1,589.00
Rate for Payer: Cofinity Commercial	$1,293.37
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 HMO/PPO/Tiered Network	$1,128.98
Rate for Payer: Priority Health Narrow Network	$903.18
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	$1,148.56
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: BCBS Trust/PPO	$1,148.56
Rate for Payer: BCN Commercial	$1,148.56
Rate for Payer: Cash Price	$666.46
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 HMO/PPO/Tiered Network	$424.21
Rate for Payer: Priority Health Narrow Network	$339.37
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	$383.18
Max. Negotiated Rate	$1,320.74
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: BCBS Trust/PPO	$1,320.74
Rate for Payer: BCN Commercial	$1,320.74
Rate for Payer: Cash Price	$766.37
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 HMO/PPO/Tiered Network	$487.80
Rate for Payer: Priority Health Narrow Network	$390.24
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	$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 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

Know your out-of-pocket cost for care.

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