Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$554.15
Max. Negotiated Rate	$2,247.00
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: BCBS Trust/PPO	$2,247.00
Rate for Payer: BCN Commercial	$2,247.00
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cofinity Commercial	$969.76
Rate for Payer: Cofinity Commercial	$1,191.42
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 HMO/PPO/Tiered Network	$829.91
Rate for Payer: Priority Health Narrow Network	$663.93
Rate for Payer: Priority Health SBD	$872.78
Rate for Payer: UHC All Payor (Choice/PPO)	$972.55

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 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	$396.98
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: BCBS Trust/PPO	$1,335.74
Rate for Payer: BCN Commercial	$1,335.74
Rate for Payer: Cash Price	$1,303.89
Rate for Payer: Cash Price	$1,303.89
Rate for Payer: Cofinity Commercial	$1,401.68
Rate for Payer: Cofinity Commercial	$1,140.90
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 HMO/PPO/Tiered Network	$496.23
Rate for Payer: Priority Health Narrow Network	$396.98
Rate for Payer: Priority Health SBD	$1,026.81
Rate for Payer: UHC All Payor (Choice/PPO)	$801.82

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 KNEE IMMOBILIZER

Facility

$202.83

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$55.11
Max. Negotiated Rate	$185.42
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: BCBS Trust/PPO	$185.42
Rate for Payer: BCN Commercial	$185.42
Rate for Payer: Cash Price	$162.26
Rate for Payer: Cash Price	$162.26
Rate for Payer: Cofinity Commercial	$174.43
Rate for Payer: Cofinity Commercial	$141.98
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 HMO/PPO/Tiered Network	$68.89
Rate for Payer: Priority Health Narrow Network	$55.11
Rate for Payer: Priority Health SBD	$127.78
Rate for Payer: UHC All Payor (Choice/PPO)	$102.53

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 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	$1,340.84
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: BCBS Trust/PPO	$1,340.84
Rate for Payer: BCN Commercial	$1,340.84
Rate for Payer: Cash Price	$521.42
Rate for Payer: Cash Price	$521.42
Rate for Payer: Cofinity Commercial	$560.53
Rate for Payer: Cofinity Commercial	$456.25
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 HMO/PPO/Tiered Network	$495.23
Rate for Payer: Priority Health Narrow Network	$396.18
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	$74.26
Max. Negotiated Rate	$254.27
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: BCBS Trust/PPO	$254.27
Rate for Payer: BCN Commercial	$254.27
Rate for Payer: Cash Price	$148.51
Rate for Payer: Cash Price	$148.51
Rate for Payer: Cofinity Commercial	$159.65
Rate for Payer: Cofinity Commercial	$129.95
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 HMO/PPO/Tiered Network	$93.91
Rate for Payer: Priority Health Narrow Network	$75.13
Rate for Payer: Priority Health SBD	$116.95
Rate for Payer: UHC All Payor (Choice/PPO)	$110.05

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 OTS

Facility

$194.92

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$40.04
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: BCBS Trust/PPO	$134.72
Rate for Payer: BCN Commercial	$134.72
Rate for Payer: Cash Price	$155.94
Rate for Payer: Cash Price	$155.94
Rate for Payer: Cofinity Commercial	$167.63
Rate for Payer: Cofinity Commercial	$136.44
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 HMO/PPO/Tiered Network	$50.05
Rate for Payer: Priority Health Narrow Network	$40.04
Rate for Payer: Priority Health SBD	$122.80
Rate for Payer: UHC All Payor (Choice/PPO)	$89.38

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	$1,609.34
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 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 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	$1,087.71
Max. Negotiated Rate	$4,226.20
Rate for Payer: Aetna Commercial	$2,311.39
Rate for Payer: Aetna Medicare	$1,359.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,767.53
Rate for Payer: BCBS Complete	$1,087.71
Rate for Payer: BCBS Trust/PPO	$4,226.20
Rate for Payer: BCN Commercial	$4,226.20
Rate for Payer: Cash Price	$2,175.42
Rate for Payer: Cash Price	$2,175.42
Rate for Payer: Cofinity Commercial	$2,338.58
Rate for Payer: Cofinity Commercial	$1,903.50
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 HMO/PPO/Tiered Network	$1,560.91
Rate for Payer: Priority Health Narrow Network	$1,248.73
Rate for Payer: Priority Health SBD	$1,713.15
Rate for Payer: UHC All Payor (Choice/PPO)	$1,829.20

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

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$371.81

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$234.24
Max. Negotiated Rate	$334.63
Rate for Payer: Aetna Commercial	$316.04
Rate for Payer: Aetna New Business (MI Preferred)	$241.68
Rate for Payer: Cash Price	$297.45
Rate for Payer: Cofinity Commercial	$260.27
Rate for Payer: Cofinity Commercial	$319.76
Rate for Payer: Cofinity Medicare Advantage	$260.27
Rate for Payer: Encore Health Key Benefits Commercial	$297.45
Rate for Payer: Healthscope Commercial	$334.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.04
Rate for Payer: PHP Commercial	$316.04
Rate for Payer: Priority Health Cigna Priority Health	$241.68
Rate for Payer: Priority Health SBD	$234.24

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$371.81

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$148.72
Max. Negotiated Rate	$512.55
Rate for Payer: Aetna Commercial	$316.04
Rate for Payer: Aetna Medicare	$185.90
Rate for Payer: Aetna New Business (MI Preferred)	$241.68
Rate for Payer: BCBS Complete	$148.72
Rate for Payer: BCBS Trust/PPO	$512.55
Rate for Payer: BCN Commercial	$512.55
Rate for Payer: Cash Price	$297.45
Rate for Payer: Cash Price	$297.45
Rate for Payer: Cofinity Commercial	$319.76
Rate for Payer: Cofinity Commercial	$260.27
Rate for Payer: Cofinity Medicare Advantage	$260.27
Rate for Payer: Encore Health Key Benefits Commercial	$297.45
Rate for Payer: Healthscope Commercial	$334.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.04
Rate for Payer: PHP Commercial	$316.04
Rate for Payer: Priority Health Cigna Priority Health	$241.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.31
Rate for Payer: Priority Health Narrow Network	$151.45
Rate for Payer: Priority Health SBD	$234.24
Rate for Payer: UHC All Payor (Choice/PPO)	$221.84

HC BRACE PRAFO CUSTOM

Facility

$397.09

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$158.84
Max. Negotiated Rate	$547.43
Rate for Payer: Aetna Commercial	$337.53
Rate for Payer: Aetna Medicare	$198.54
Rate for Payer: Aetna New Business (MI Preferred)	$258.11
Rate for Payer: BCBS Complete	$158.84
Rate for Payer: BCBS Trust/PPO	$547.43
Rate for Payer: BCN Commercial	$547.43
Rate for Payer: Cash Price	$317.67
Rate for Payer: Cash Price	$317.67
Rate for Payer: Cofinity Commercial	$341.50
Rate for Payer: Cofinity Commercial	$277.96
Rate for Payer: Cofinity Medicare Advantage	$277.96
Rate for Payer: Encore Health Key Benefits Commercial	$317.67
Rate for Payer: Healthscope Commercial	$357.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.53
Rate for Payer: PHP Commercial	$337.53
Rate for Payer: Priority Health Cigna Priority Health	$258.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$202.19
Rate for Payer: Priority Health Narrow Network	$161.75
Rate for Payer: Priority Health SBD	$250.17
Rate for Payer: UHC All Payor (Choice/PPO)	$236.94

HC BRACE PRAFO CUSTOM

Facility

$397.09

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$250.17
Max. Negotiated Rate	$357.38
Rate for Payer: Aetna Commercial	$337.53
Rate for Payer: Aetna New Business (MI Preferred)	$258.11
Rate for Payer: Cash Price	$317.67
Rate for Payer: Cofinity Commercial	$277.96
Rate for Payer: Cofinity Commercial	$341.50
Rate for Payer: Cofinity Medicare Advantage	$277.96
Rate for Payer: Encore Health Key Benefits Commercial	$317.67
Rate for Payer: Healthscope Commercial	$357.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.53
Rate for Payer: PHP Commercial	$337.53
Rate for Payer: Priority Health Cigna Priority Health	$258.11
Rate for Payer: Priority Health SBD	$250.17

HC BRACE PRAFO OTS

Facility

$436.79

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$275.18
Max. Negotiated Rate	$393.11
Rate for Payer: Aetna Commercial	$371.27
Rate for Payer: Aetna New Business (MI Preferred)	$283.91
Rate for Payer: Cash Price	$349.43
Rate for Payer: Cofinity Commercial	$305.75
Rate for Payer: Cofinity Commercial	$375.64
Rate for Payer: Cofinity Medicare Advantage	$305.75
Rate for Payer: Encore Health Key Benefits Commercial	$349.43
Rate for Payer: Healthscope Commercial	$393.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.27
Rate for Payer: PHP Commercial	$371.27
Rate for Payer: Priority Health Cigna Priority Health	$283.91
Rate for Payer: Priority Health SBD	$275.18

HC BRACE PRAFO OTS

Facility

$436.79

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$161.75
Max. Negotiated Rate	$547.43
Rate for Payer: Aetna Commercial	$371.27
Rate for Payer: Aetna Medicare	$218.40
Rate for Payer: Aetna New Business (MI Preferred)	$283.91
Rate for Payer: BCBS Complete	$174.72
Rate for Payer: BCBS Trust/PPO	$547.43
Rate for Payer: BCN Commercial	$547.43
Rate for Payer: Cash Price	$349.43
Rate for Payer: Cash Price	$349.43
Rate for Payer: Cofinity Commercial	$375.64
Rate for Payer: Cofinity Commercial	$305.75
Rate for Payer: Cofinity Medicare Advantage	$305.75
Rate for Payer: Encore Health Key Benefits Commercial	$349.43
Rate for Payer: Healthscope Commercial	$393.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.27
Rate for Payer: PHP Commercial	$371.27
Rate for Payer: Priority Health Cigna Priority Health	$283.91
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$202.19
Rate for Payer: Priority Health Narrow Network	$161.75
Rate for Payer: Priority Health SBD	$275.18

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$538.45

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$339.22
Max. Negotiated Rate	$484.60
Rate for Payer: Aetna Commercial	$457.68
Rate for Payer: Aetna New Business (MI Preferred)	$349.99
Rate for Payer: Cash Price	$430.76
Rate for Payer: Cofinity Commercial	$376.92
Rate for Payer: Cofinity Commercial	$463.07
Rate for Payer: Cofinity Medicare Advantage	$376.92
Rate for Payer: Encore Health Key Benefits Commercial	$430.76
Rate for Payer: Healthscope Commercial	$484.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.68
Rate for Payer: PHP Commercial	$457.68
Rate for Payer: Priority Health Cigna Priority Health	$349.99
Rate for Payer: Priority Health SBD	$339.22

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$538.45

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$215.38
Max. Negotiated Rate	$742.36
Rate for Payer: Aetna Commercial	$457.68
Rate for Payer: Aetna Medicare	$269.22
Rate for Payer: Aetna New Business (MI Preferred)	$349.99
Rate for Payer: BCBS Complete	$215.38
Rate for Payer: BCBS Trust/PPO	$742.36
Rate for Payer: BCN Commercial	$742.36
Rate for Payer: Cash Price	$430.76
Rate for Payer: Cash Price	$430.76
Rate for Payer: Cofinity Commercial	$463.07
Rate for Payer: Cofinity Commercial	$376.92
Rate for Payer: Cofinity Medicare Advantage	$376.92
Rate for Payer: Encore Health Key Benefits Commercial	$430.76
Rate for Payer: Healthscope Commercial	$484.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.68
Rate for Payer: PHP Commercial	$457.68
Rate for Payer: Priority Health Cigna Priority Health	$349.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$274.19
Rate for Payer: Priority Health Narrow Network	$219.35
Rate for Payer: Priority Health SBD	$339.22
Rate for Payer: UHC All Payor (Choice/PPO)	$321.31

Know your out-of-pocket cost for care.

All Charges