Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE RIGID NECK

Facility

$185.06

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$116.59
Max. Negotiated Rate	$166.55
Rate for Payer: Aetna Commercial	$157.30
Rate for Payer: Aetna New Business (MI Preferred)	$120.29
Rate for Payer: Cash Price	$148.05
Rate for Payer: Cofinity Commercial	$129.54
Rate for Payer: Cofinity Commercial	$159.15
Rate for Payer: Cofinity Medicare Advantage	$129.54
Rate for Payer: Encore Health Key Benefits Commercial	$148.05
Rate for Payer: Healthscope Commercial	$166.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.30
Rate for Payer: PHP Commercial	$157.30
Rate for Payer: Priority Health Cigna Priority Health	$120.29
Rate for Payer: Priority Health SBD	$116.59

HC BRACE RIGID NECK

Facility

$185.06

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$57.70
Max. Negotiated Rate	$195.27
Rate for Payer: Aetna Commercial	$157.30
Rate for Payer: Aetna Medicare	$92.53
Rate for Payer: Aetna New Business (MI Preferred)	$120.29
Rate for Payer: BCBS Complete	$74.02
Rate for Payer: BCBS Trust/PPO	$195.27
Rate for Payer: BCN Commercial	$195.27
Rate for Payer: Cash Price	$148.05
Rate for Payer: Cash Price	$148.05
Rate for Payer: Cofinity Commercial	$159.15
Rate for Payer: Cofinity Commercial	$129.54
Rate for Payer: Cofinity Medicare Advantage	$129.54
Rate for Payer: Encore Health Key Benefits Commercial	$148.05
Rate for Payer: Healthscope Commercial	$166.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.30
Rate for Payer: PHP Commercial	$157.30
Rate for Payer: Priority Health Cigna Priority Health	$120.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.12
Rate for Payer: Priority Health Narrow Network	$57.70
Rate for Payer: Priority Health SBD	$116.59

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$537.89

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$215.16
Max. Negotiated Rate	$2,140.79
Rate for Payer: Aetna Commercial	$457.21
Rate for Payer: Aetna Medicare	$268.94
Rate for Payer: Aetna New Business (MI Preferred)	$349.63
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCBS Trust/PPO	$2,140.79
Rate for Payer: BCN Commercial	$2,140.79
Rate for Payer: Cash Price	$430.31
Rate for Payer: Cash Price	$430.31
Rate for Payer: Cofinity Commercial	$462.59
Rate for Payer: Cofinity Commercial	$376.52
Rate for Payer: Cofinity Medicare Advantage	$376.52
Rate for Payer: Encore Health Key Benefits Commercial	$430.31
Rate for Payer: Healthscope Commercial	$484.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.21
Rate for Payer: PHP Commercial	$457.21
Rate for Payer: Priority Health Cigna Priority Health	$349.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$790.68
Rate for Payer: Priority Health Narrow Network	$632.54
Rate for Payer: Priority Health SBD	$338.87

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$537.89

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$338.87
Max. Negotiated Rate	$484.10
Rate for Payer: Aetna Commercial	$457.21
Rate for Payer: Aetna New Business (MI Preferred)	$349.63
Rate for Payer: Cash Price	$430.31
Rate for Payer: Cofinity Commercial	$376.52
Rate for Payer: Cofinity Commercial	$462.59
Rate for Payer: Cofinity Medicare Advantage	$376.52
Rate for Payer: Encore Health Key Benefits Commercial	$430.31
Rate for Payer: Healthscope Commercial	$484.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.21
Rate for Payer: PHP Commercial	$457.21
Rate for Payer: Priority Health Cigna Priority Health	$349.63
Rate for Payer: Priority Health SBD	$338.87

HC BRACE SOFT COLLAR

Facility

$60.66

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$86.28
Rate for Payer: Aetna Commercial	$51.56
Rate for Payer: Aetna Medicare	$30.33
Rate for Payer: Aetna New Business (MI Preferred)	$39.43
Rate for Payer: BCBS Complete	$24.26
Rate for Payer: BCBS Trust/PPO	$86.28
Rate for Payer: BCN Commercial	$86.28
Rate for Payer: Cash Price	$48.53
Rate for Payer: Cash Price	$48.53
Rate for Payer: Cofinity Commercial	$42.46
Rate for Payer: Cofinity Commercial	$52.17
Rate for Payer: Cofinity Medicare Advantage	$42.46
Rate for Payer: Encore Health Key Benefits Commercial	$48.53
Rate for Payer: Healthscope Commercial	$54.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.56
Rate for Payer: PHP Commercial	$51.56
Rate for Payer: Priority Health Cigna Priority Health	$39.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.87
Rate for Payer: Priority Health Narrow Network	$25.50
Rate for Payer: Priority Health SBD	$38.22

HC BRACE SOFT COLLAR

Facility

$60.66

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$54.59
Rate for Payer: Aetna Commercial	$51.56
Rate for Payer: Aetna New Business (MI Preferred)	$39.43
Rate for Payer: Cash Price	$48.53
Rate for Payer: Cofinity Commercial	$42.46
Rate for Payer: Cofinity Commercial	$52.17
Rate for Payer: Cofinity Medicare Advantage	$42.46
Rate for Payer: Encore Health Key Benefits Commercial	$48.53
Rate for Payer: Healthscope Commercial	$54.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.56
Rate for Payer: PHP Commercial	$51.56
Rate for Payer: Priority Health Cigna Priority Health	$39.43
Rate for Payer: Priority Health SBD	$38.22

HC BRACE SOFT HELMET

Facility

$315.66

Service Code	HCPCS A8000
Hospital Charge Code	27000006
Hospital Revenue Code	274
Min. Negotiated Rate	$198.87
Max. Negotiated Rate	$284.09
Rate for Payer: Aetna Commercial	$268.31
Rate for Payer: Aetna New Business (MI Preferred)	$205.18
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cofinity Commercial	$220.96
Rate for Payer: Cofinity Commercial	$271.47
Rate for Payer: Cofinity Medicare Advantage	$220.96
Rate for Payer: Encore Health Key Benefits Commercial	$252.53
Rate for Payer: Healthscope Commercial	$284.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.31
Rate for Payer: PHP Commercial	$268.31
Rate for Payer: Priority Health Cigna Priority Health	$205.18
Rate for Payer: Priority Health SBD	$198.87

HC BRACE SOFT HELMET

Facility

$315.66

Service Code	HCPCS A8000
Hospital Charge Code	27000006
Hospital Revenue Code	274
Min. Negotiated Rate	$126.26
Max. Negotiated Rate	$284.09
Rate for Payer: Aetna Commercial	$268.31
Rate for Payer: Aetna Medicare	$157.83
Rate for Payer: Aetna New Business (MI Preferred)	$205.18
Rate for Payer: BCBS Complete	$126.26
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cofinity Commercial	$220.96
Rate for Payer: Cofinity Commercial	$271.47
Rate for Payer: Cofinity Medicare Advantage	$220.96
Rate for Payer: Encore Health Key Benefits Commercial	$252.53
Rate for Payer: Healthscope Commercial	$284.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.31
Rate for Payer: PHP Commercial	$268.31
Rate for Payer: Priority Health Cigna Priority Health	$205.18
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	$198.87

HC BRACE STUMP SHRINKER AK

Facility

$157.10

Service Code	HCPCS L8460
Hospital Charge Code	27000015
Hospital Revenue Code	274
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$216.59
Rate for Payer: Aetna Commercial	$133.54
Rate for Payer: Aetna Medicare	$78.55
Rate for Payer: Aetna New Business (MI Preferred)	$102.12
Rate for Payer: BCBS Complete	$62.84
Rate for Payer: BCBS Trust/PPO	$216.59
Rate for Payer: BCN Commercial	$216.59
Rate for Payer: Cash Price	$125.68
Rate for Payer: Cash Price	$125.68
Rate for Payer: Cofinity Commercial	$135.11
Rate for Payer: Cofinity Commercial	$109.97
Rate for Payer: Cofinity Medicare Advantage	$109.97
Rate for Payer: Encore Health Key Benefits Commercial	$125.68
Rate for Payer: Healthscope Commercial	$141.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.54
Rate for Payer: PHP Commercial	$133.54
Rate for Payer: Priority Health Cigna Priority Health	$102.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.99
Rate for Payer: Priority Health Narrow Network	$63.99
Rate for Payer: Priority Health SBD	$98.97

HC BRACE STUMP SHRINKER AK

Facility

$157.10

Service Code	HCPCS L8460
Hospital Charge Code	27000015
Hospital Revenue Code	274
Min. Negotiated Rate	$98.97
Max. Negotiated Rate	$141.39
Rate for Payer: Aetna Commercial	$133.54
Rate for Payer: Aetna New Business (MI Preferred)	$102.12
Rate for Payer: Cash Price	$125.68
Rate for Payer: Cofinity Commercial	$109.97
Rate for Payer: Cofinity Commercial	$135.11
Rate for Payer: Cofinity Medicare Advantage	$109.97
Rate for Payer: Encore Health Key Benefits Commercial	$125.68
Rate for Payer: Healthscope Commercial	$141.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.54
Rate for Payer: PHP Commercial	$133.54
Rate for Payer: Priority Health Cigna Priority Health	$102.12
Rate for Payer: Priority Health SBD	$98.97

HC BRACE STUMP SHRINKER BK

Facility

$110.53

Service Code	HCPCS L8440
Hospital Charge Code	27000016
Hospital Revenue Code	274
Min. Negotiated Rate	$44.21
Max. Negotiated Rate	$152.35
Rate for Payer: Aetna Commercial	$93.95
Rate for Payer: Aetna Medicare	$55.26
Rate for Payer: Aetna New Business (MI Preferred)	$71.84
Rate for Payer: BCBS Complete	$44.21
Rate for Payer: BCBS Trust/PPO	$152.35
Rate for Payer: BCN Commercial	$152.35
Rate for Payer: Cash Price	$88.42
Rate for Payer: Cash Price	$88.42
Rate for Payer: Cofinity Commercial	$95.06
Rate for Payer: Cofinity Commercial	$77.37
Rate for Payer: Cofinity Medicare Advantage	$77.37
Rate for Payer: Encore Health Key Benefits Commercial	$88.42
Rate for Payer: Healthscope Commercial	$99.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.95
Rate for Payer: PHP Commercial	$93.95
Rate for Payer: Priority Health Cigna Priority Health	$71.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.27
Rate for Payer: Priority Health Narrow Network	$45.02
Rate for Payer: Priority Health SBD	$69.63
Rate for Payer: UHC All Payor (Choice/PPO)	$65.94

HC BRACE STUMP SHRINKER BK

Facility

$110.53

Service Code	HCPCS L8440
Hospital Charge Code	27000016
Hospital Revenue Code	274
Min. Negotiated Rate	$69.63
Max. Negotiated Rate	$99.48
Rate for Payer: Aetna Commercial	$93.95
Rate for Payer: Aetna New Business (MI Preferred)	$71.84
Rate for Payer: Cash Price	$88.42
Rate for Payer: Cofinity Commercial	$77.37
Rate for Payer: Cofinity Commercial	$95.06
Rate for Payer: Cofinity Medicare Advantage	$77.37
Rate for Payer: Encore Health Key Benefits Commercial	$88.42
Rate for Payer: Healthscope Commercial	$99.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.95
Rate for Payer: PHP Commercial	$93.95
Rate for Payer: Priority Health Cigna Priority Health	$71.84
Rate for Payer: Priority Health SBD	$69.63

HC BRACE THUMB SPICA SPLINT

Facility

$98.42

Service Code	HCPCS L3908
Hospital Charge Code	27400017
Hospital Revenue Code	274
Min. Negotiated Rate	$39.37
Max. Negotiated Rate	$217.67
Rate for Payer: Aetna Commercial	$83.66
Rate for Payer: Aetna Medicare	$49.21
Rate for Payer: Aetna New Business (MI Preferred)	$63.97
Rate for Payer: BCBS Complete	$39.37
Rate for Payer: BCBS Trust/PPO	$217.67
Rate for Payer: BCN Commercial	$217.67
Rate for Payer: Cash Price	$78.74
Rate for Payer: Cash Price	$78.74
Rate for Payer: Cofinity Commercial	$84.64
Rate for Payer: Cofinity Commercial	$68.89
Rate for Payer: Cofinity Medicare Advantage	$68.89
Rate for Payer: Encore Health Key Benefits Commercial	$78.74
Rate for Payer: Healthscope Commercial	$88.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.66
Rate for Payer: PHP Commercial	$83.66
Rate for Payer: Priority Health Cigna Priority Health	$63.97
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	$62.00
Rate for Payer: UHC All Payor (Choice/PPO)	$94.21

HC BRACE THUMB SPICA SPLINT

Facility

$98.42

Service Code	HCPCS L3908
Hospital Charge Code	27400017
Hospital Revenue Code	274
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$88.58
Rate for Payer: Aetna Commercial	$83.66
Rate for Payer: Aetna New Business (MI Preferred)	$63.97
Rate for Payer: Cash Price	$78.74
Rate for Payer: Cofinity Commercial	$68.89
Rate for Payer: Cofinity Commercial	$84.64
Rate for Payer: Cofinity Medicare Advantage	$68.89
Rate for Payer: Encore Health Key Benefits Commercial	$78.74
Rate for Payer: Healthscope Commercial	$88.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.66
Rate for Payer: PHP Commercial	$83.66
Rate for Payer: Priority Health Cigna Priority Health	$63.97
Rate for Payer: Priority Health SBD	$62.00

HC BRACE TLSO

Facility

$3,264.00

Service Code	HCPCS L0486
Hospital Charge Code	27400007
Hospital Revenue Code	274
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$6,675.35
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: BCBS Trust/PPO	$6,675.35
Rate for Payer: BCN Commercial	$6,675.35
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,465.48
Rate for Payer: Priority Health Narrow Network	$1,972.38
Rate for Payer: Priority Health SBD	$2,056.32
Rate for Payer: UHC All Payor (Choice/PPO)	$2,889.24

HC BRACE TLSO

Facility

$3,264.00

Service Code	HCPCS L0486
Hospital Charge Code	27400007
Hospital Revenue Code	274
Min. Negotiated Rate	$2,056.32
Max. Negotiated Rate	$2,937.60
Rate for Payer: Aetna Commercial	$2,774.40
Rate for Payer: Aetna New Business (MI Preferred)	$2,121.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$2,284.80
Rate for Payer: Cofinity Commercial	$2,807.04
Rate for Payer: Cofinity Medicare Advantage	$2,284.80
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: PHP Commercial	$2,774.40
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health SBD	$2,056.32

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,206.67
Max. Negotiated Rate	$4,849.07
Rate for Payer: Aetna Commercial	$2,564.18
Rate for Payer: Aetna Medicare	$1,508.34
Rate for Payer: Aetna New Business (MI Preferred)	$1,960.84
Rate for Payer: BCBS Complete	$1,206.67
Rate for Payer: BCBS Trust/PPO	$4,849.07
Rate for Payer: BCN Commercial	$4,849.07
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,594.34
Rate for Payer: Cofinity Commercial	$2,111.68
Rate for Payer: Cofinity Medicare Advantage	$2,111.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: PHP Commercial	$2,564.18
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,790.97
Rate for Payer: Priority Health Narrow Network	$1,432.78
Rate for Payer: Priority Health SBD	$1,900.51
Rate for Payer: UHC All Payor (Choice/PPO)	$2,098.79

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,900.51
Max. Negotiated Rate	$2,715.01
Rate for Payer: Aetna Commercial	$2,564.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,960.84
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,111.68
Rate for Payer: Cofinity Commercial	$2,594.34
Rate for Payer: Cofinity Medicare Advantage	$2,111.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: PHP Commercial	$2,564.18
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: Priority Health SBD	$1,900.51

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$1,262.23
Max. Negotiated Rate	$1,803.19
Rate for Payer: Aetna Commercial	$1,703.01
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.30
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,402.48
Rate for Payer: Cofinity Commercial	$1,723.04
Rate for Payer: Cofinity Medicare Advantage	$1,402.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: PHP Commercial	$1,703.01
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: Priority Health SBD	$1,262.23

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$801.42
Max. Negotiated Rate	$3,274.71
Rate for Payer: Aetna Commercial	$1,703.01
Rate for Payer: Aetna Medicare	$1,001.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.30
Rate for Payer: BCBS Complete	$801.42
Rate for Payer: BCBS Trust/PPO	$3,274.71
Rate for Payer: BCN Commercial	$3,274.71
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,723.04
Rate for Payer: Cofinity Commercial	$1,402.48
Rate for Payer: Cofinity Medicare Advantage	$1,402.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: PHP Commercial	$1,703.01
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,209.49
Rate for Payer: Priority Health Narrow Network	$967.59
Rate for Payer: Priority Health SBD	$1,262.23
Rate for Payer: UHC All Payor (Choice/PPO)	$1,417.37

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$1,166.22
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna Medicare	$23.97
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: BCBS Complete	$19.18
Rate for Payer: BCBS Trust/PPO	$1,166.22
Rate for Payer: BCN Commercial	$1,166.22
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Cofinity Medicare Advantage	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$430.74
Rate for Payer: Priority Health Narrow Network	$344.59
Rate for Payer: Priority Health SBD	$30.20

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$43.15
Rate for Payer: Aetna Commercial	$40.75
Rate for Payer: Aetna New Business (MI Preferred)	$31.16
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$33.56
Rate for Payer: Cofinity Commercial	$41.23
Rate for Payer: Cofinity Medicare Advantage	$33.56
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: PHP Commercial	$40.75
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: Priority Health SBD	$30.20

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$217.67
Rate for Payer: Aetna Commercial	$30.73
Rate for Payer: Aetna Medicare	$18.08
Rate for Payer: Aetna New Business (MI Preferred)	$23.50
Rate for Payer: BCBS Complete	$14.46
Rate for Payer: BCBS Trust/PPO	$217.67
Rate for Payer: BCN Commercial	$217.67
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Commercial	$25.30
Rate for Payer: Cofinity Medicare Advantage	$25.30
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$32.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: PHP Commercial	$30.73
Rate for Payer: Priority Health Cigna Priority Health	$23.50
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	$22.77
Rate for Payer: UHC All Payor (Choice/PPO)	$94.21

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$32.54
Rate for Payer: Aetna Commercial	$30.73
Rate for Payer: Aetna New Business (MI Preferred)	$23.50
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$25.30
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Medicare Advantage	$25.30
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$32.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: PHP Commercial	$30.73
Rate for Payer: Priority Health Cigna Priority Health	$23.50
Rate for Payer: Priority Health SBD	$22.77

HC BRACE WAIST BELT

Facility

$147.52

Service Code	HCPCS L5688
Hospital Charge Code	27400031
Hospital Revenue Code	274
Min. Negotiated Rate	$59.01
Max. Negotiated Rate	$199.81
Rate for Payer: Aetna Commercial	$125.39
Rate for Payer: Aetna Medicare	$73.76
Rate for Payer: Aetna New Business (MI Preferred)	$95.89
Rate for Payer: BCBS Complete	$59.01
Rate for Payer: BCBS Trust/PPO	$199.81
Rate for Payer: BCN Commercial	$199.81
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cofinity Commercial	$103.26
Rate for Payer: Cofinity Commercial	$126.87
Rate for Payer: Cofinity Medicare Advantage	$103.26
Rate for Payer: Encore Health Key Benefits Commercial	$118.02
Rate for Payer: Healthscope Commercial	$132.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.39
Rate for Payer: PHP Commercial	$125.39
Rate for Payer: Priority Health Cigna Priority Health	$95.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.80
Rate for Payer: Priority Health Narrow Network	$59.04
Rate for Payer: Priority Health SBD	$92.94

Know your out-of-pocket cost for care.

All Charges