|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.79 |
| Max. Negotiated Rate |
$291.01 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna Medicare |
$84.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.04
|
| Rate for Payer: BCBS Complete |
$129.34
|
| Rate for Payer: BCBS MAPPO |
$80.84
|
| Rate for Payer: BCBS Trust/PPO |
$251.40
|
| Rate for Payer: BCN Commercial |
$251.40
|
| Rate for Payer: BCN Medicare Advantage |
$80.84
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PACE Senior Care Partners |
$76.79
|
| Rate for Payer: PACE SWMI |
$80.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: PHP Medicare Advantage |
$80.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.31
|
| Rate for Payer: Priority Health Medicare |
$80.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.21
|
| Rate for Payer: Railroad Medicare Medicare |
$80.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.54
|
| Rate for Payer: UHC Core |
$269.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.84
|
| Rate for Payer: UHC Medicare Advantage |
$83.26
|
| Rate for Payer: VA VA |
$80.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.50
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: BCBS Trust/PPO |
$100.39
|
| Rate for Payer: BCN Commercial |
$100.39
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.92
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.31
|
| Rate for Payer: UHC Core |
$108.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.42
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna Medicare |
$33.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.59
|
| Rate for Payer: BCBS Complete |
$51.96
|
| Rate for Payer: BCBS MAPPO |
$32.48
|
| Rate for Payer: BCBS Trust/PPO |
$101.00
|
| Rate for Payer: BCN Commercial |
$101.00
|
| Rate for Payer: BCN Medicare Advantage |
$32.48
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PACE Senior Care Partners |
$30.85
|
| Rate for Payer: PACE SWMI |
$32.48
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: PHP Medicare Advantage |
$32.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.01
|
| Rate for Payer: Priority Health Medicare |
$32.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.23
|
| Rate for Payer: Railroad Medicare Medicare |
$32.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.31
|
| Rate for Payer: UHC Core |
$108.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.48
|
| Rate for Payer: UHC Medicare Advantage |
$33.45
|
| Rate for Payer: VA VA |
$32.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.42
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,321.00 |
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: Aetna Medicare |
$381.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.68
|
| Rate for Payer: BCBS Complete |
$587.11
|
| Rate for Payer: BCBS MAPPO |
$366.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.20
|
| Rate for Payer: BCN Commercial |
$1,141.20
|
| Rate for Payer: BCN Medicare Advantage |
$366.94
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.94
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PACE Senior Care Partners |
$348.60
|
| Rate for Payer: PACE SWMI |
$366.94
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: PHP Medicare Advantage |
$366.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,276.97
|
| Rate for Payer: Priority Health Medicare |
$366.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$895.20
|
| Rate for Payer: Railroad Medicare Medicare |
$366.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,291.65
|
| Rate for Payer: UHC Core |
$1,225.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.94
|
| Rate for Payer: UHC Medicare Advantage |
$377.95
|
| Rate for Payer: VA VA |
$366.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$1,321.00 |
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.30
|
| Rate for Payer: BCN Commercial |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.22
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,276.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$895.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,291.65
|
| Rate for Payer: UHC Core |
$1,225.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: BCBS Trust/PPO |
$111.71
|
| Rate for Payer: BCN Commercial |
$111.71
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.64
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.20
|
| Rate for Payer: UHC Core |
$120.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.41
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: Aetna Medicare |
$37.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.17
|
| Rate for Payer: BCBS Complete |
$57.82
|
| Rate for Payer: BCBS MAPPO |
$36.14
|
| Rate for Payer: BCBS Trust/PPO |
$112.39
|
| Rate for Payer: BCN Commercial |
$112.39
|
| Rate for Payer: BCN Medicare Advantage |
$36.14
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.14
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PACE Senior Care Partners |
$34.33
|
| Rate for Payer: PACE SWMI |
$36.14
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: PHP Medicare Advantage |
$36.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.76
|
| Rate for Payer: Priority Health Medicare |
$36.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.16
|
| Rate for Payer: Railroad Medicare Medicare |
$36.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.20
|
| Rate for Payer: UHC Core |
$120.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.14
|
| Rate for Payer: UHC Medicare Advantage |
$37.22
|
| Rate for Payer: VA VA |
$36.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.41
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$301.59 |
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: Aetna Medicare |
$87.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.72
|
| Rate for Payer: BCBS Complete |
$134.04
|
| Rate for Payer: BCBS MAPPO |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$260.54
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: BCN Medicare Advantage |
$83.78
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.78
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PACE Senior Care Partners |
$79.59
|
| Rate for Payer: PACE SWMI |
$83.78
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: PHP Medicare Advantage |
$83.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.54
|
| Rate for Payer: Priority Health Medicare |
$83.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.38
|
| Rate for Payer: Railroad Medicare Medicare |
$83.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.89
|
| Rate for Payer: UHC Core |
$279.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.78
|
| Rate for Payer: UHC Medicare Advantage |
$86.29
|
| Rate for Payer: VA VA |
$83.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.32
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$204.38 |
| Max. Negotiated Rate |
$301.59 |
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: BCBS Trust/PPO |
$258.97
|
| Rate for Payer: BCN Commercial |
$258.97
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.08
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.89
|
| Rate for Payer: UHC Core |
$279.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.32
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.53
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS MAPPO |
$74.02
|
| Rate for Payer: BCBS Trust/PPO |
$230.22
|
| Rate for Payer: BCN Commercial |
$230.22
|
| Rate for Payer: BCN Medicare Advantage |
$74.02
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.02
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PACE Senior Care Partners |
$70.32
|
| Rate for Payer: PACE SWMI |
$74.02
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.61
|
| Rate for Payer: Priority Health Medicare |
$74.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.59
|
| Rate for Payer: Railroad Medicare Medicare |
$74.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.02
|
| Rate for Payer: UHC Medicare Advantage |
$76.25
|
| Rate for Payer: VA VA |
$74.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.59 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: BCBS Trust/PPO |
$228.83
|
| Rate for Payer: BCN Commercial |
$228.83
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: Aetna Medicare |
$24.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.43
|
| Rate for Payer: BCBS Complete |
$37.67
|
| Rate for Payer: BCBS MAPPO |
$23.54
|
| Rate for Payer: BCBS Trust/PPO |
$73.22
|
| Rate for Payer: BCN Commercial |
$73.22
|
| Rate for Payer: BCN Medicare Advantage |
$23.54
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.37
|
| Rate for Payer: PACE SWMI |
$23.54
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: PHP Medicare Advantage |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.93
|
| Rate for Payer: Priority Health Medicare |
$23.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: Railroad Medicare Medicare |
$23.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.87
|
| Rate for Payer: UHC Core |
$78.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.54
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
| Rate for Payer: VA VA |
$23.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.63
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: BCBS Trust/PPO |
$72.77
|
| Rate for Payer: BCN Commercial |
$72.77
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.34
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.87
|
| Rate for Payer: UHC Core |
$78.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.63
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,099.28
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$670.45 |
| Max. Negotiated Rate |
$989.35 |
| Rate for Payer: Aetna Commercial |
$934.39
|
| Rate for Payer: BCBS Trust/PPO |
$849.52
|
| Rate for Payer: BCN Commercial |
$849.52
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cofinity Commercial |
$945.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$879.42
|
| Rate for Payer: Healthscope Commercial |
$989.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$824.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$934.39
|
| Rate for Payer: PHP Commercial |
$934.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$956.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$967.37
|
| Rate for Payer: UHC Core |
$917.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$824.46
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,099.28
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.08 |
| Max. Negotiated Rate |
$989.35 |
| Rate for Payer: Aetna Commercial |
$934.39
|
| Rate for Payer: Aetna Medicare |
$285.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.52
|
| Rate for Payer: BCBS Complete |
$439.71
|
| Rate for Payer: BCBS MAPPO |
$274.82
|
| Rate for Payer: BCBS Trust/PPO |
$854.69
|
| Rate for Payer: BCN Commercial |
$854.69
|
| Rate for Payer: BCN Medicare Advantage |
$274.82
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cofinity Commercial |
$945.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$879.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.82
|
| Rate for Payer: Healthscope Commercial |
$989.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$824.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$934.39
|
| Rate for Payer: PACE Senior Care Partners |
$261.08
|
| Rate for Payer: PACE SWMI |
$274.82
|
| Rate for Payer: PHP Commercial |
$934.39
|
| Rate for Payer: PHP Medicare Advantage |
$274.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$956.37
|
| Rate for Payer: Priority Health Medicare |
$274.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.45
|
| Rate for Payer: Railroad Medicare Medicare |
$274.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$967.37
|
| Rate for Payer: UHC Core |
$917.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.82
|
| Rate for Payer: UHC Medicare Advantage |
$283.06
|
| Rate for Payer: VA VA |
$274.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$824.46
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,234.33
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$1,110.90 |
| Rate for Payer: Aetna Commercial |
$1,049.18
|
| Rate for Payer: Aetna Medicare |
$320.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.73
|
| Rate for Payer: BCBS Complete |
$493.73
|
| Rate for Payer: BCBS MAPPO |
$308.58
|
| Rate for Payer: BCBS Trust/PPO |
$959.69
|
| Rate for Payer: BCN Commercial |
$959.69
|
| Rate for Payer: BCN Medicare Advantage |
$308.58
|
| Rate for Payer: Cash Price |
$987.46
|
| Rate for Payer: Cofinity Commercial |
$1,061.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.58
|
| Rate for Payer: Healthscope Commercial |
$1,110.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$324.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
| Rate for Payer: PACE Senior Care Partners |
$293.15
|
| Rate for Payer: PACE SWMI |
$308.58
|
| Rate for Payer: PHP Commercial |
$1,049.18
|
| Rate for Payer: PHP Medicare Advantage |
$308.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,073.87
|
| Rate for Payer: Priority Health Medicare |
$308.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.82
|
| Rate for Payer: Railroad Medicare Medicare |
$308.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.21
|
| Rate for Payer: UHC Core |
$1,030.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.58
|
| Rate for Payer: UHC Medicare Advantage |
$317.84
|
| Rate for Payer: VA VA |
$308.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.75
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,234.33
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$752.82 |
| Max. Negotiated Rate |
$1,110.90 |
| Rate for Payer: Aetna Commercial |
$1,049.18
|
| Rate for Payer: BCBS Trust/PPO |
$953.89
|
| Rate for Payer: BCN Commercial |
$953.89
|
| Rate for Payer: Cash Price |
$987.46
|
| Rate for Payer: Cofinity Commercial |
$1,061.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.46
|
| Rate for Payer: Healthscope Commercial |
$1,110.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
| Rate for Payer: PHP Commercial |
$1,049.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,073.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.21
|
| Rate for Payer: UHC Core |
$1,030.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.75
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$640.40 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$892.50
|
| Rate for Payer: BCBS Trust/PPO |
$811.44
|
| Rate for Payer: BCN Commercial |
$811.44
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$903.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$840.00
|
| Rate for Payer: Healthscope Commercial |
$945.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
| Rate for Payer: PHP Commercial |
$892.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$640.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$924.00
|
| Rate for Payer: UHC Core |
$876.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$787.50
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$892.50
|
| Rate for Payer: Aetna Medicare |
$273.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$328.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$328.12
|
| Rate for Payer: BCBS Complete |
$420.00
|
| Rate for Payer: BCBS MAPPO |
$262.50
|
| Rate for Payer: BCBS Trust/PPO |
$816.38
|
| Rate for Payer: BCN Commercial |
$816.38
|
| Rate for Payer: BCN Medicare Advantage |
$262.50
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$903.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$840.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.50
|
| Rate for Payer: Healthscope Commercial |
$945.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$787.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$275.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
| Rate for Payer: PACE Senior Care Partners |
$249.38
|
| Rate for Payer: PACE SWMI |
$262.50
|
| Rate for Payer: PHP Commercial |
$892.50
|
| Rate for Payer: PHP Medicare Advantage |
$262.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.50
|
| Rate for Payer: Priority Health Medicare |
$262.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$640.40
|
| Rate for Payer: Railroad Medicare Medicare |
$262.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$924.00
|
| Rate for Payer: UHC Core |
$876.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.50
|
| Rate for Payer: UHC Medicare Advantage |
$270.38
|
| Rate for Payer: VA VA |
$262.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$787.50
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,767.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,517.53 |
| Max. Negotiated Rate |
$5,190.64 |
| Rate for Payer: Aetna Commercial |
$4,902.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,457.03
|
| Rate for Payer: BCN Commercial |
$4,457.03
|
| Rate for Payer: Cash Price |
$4,613.90
|
| Rate for Payer: Cofinity Commercial |
$4,959.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,613.90
|
| Rate for Payer: Healthscope Commercial |
$5,190.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,325.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
| Rate for Payer: PHP Commercial |
$4,902.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,017.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,517.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,075.29
|
| Rate for Payer: UHC Core |
$4,815.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,325.54
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,767.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,369.75 |
| Max. Negotiated Rate |
$5,190.64 |
| Rate for Payer: Aetna Commercial |
$4,902.27
|
| Rate for Payer: Aetna Medicare |
$1,499.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,802.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,802.31
|
| Rate for Payer: BCBS Complete |
$2,306.95
|
| Rate for Payer: BCBS MAPPO |
$1,441.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,484.14
|
| Rate for Payer: BCN Commercial |
$4,484.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.84
|
| Rate for Payer: Cash Price |
$4,613.90
|
| Rate for Payer: Cofinity Commercial |
$4,959.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,613.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.84
|
| Rate for Payer: Healthscope Commercial |
$5,190.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,325.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,658.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
| Rate for Payer: PACE Senior Care Partners |
$1,369.75
|
| Rate for Payer: PACE SWMI |
$1,441.84
|
| Rate for Payer: PHP Commercial |
$4,902.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,017.62
|
| Rate for Payer: Priority Health Medicare |
$1,441.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,517.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,075.29
|
| Rate for Payer: UHC Core |
$4,815.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.10
|
| Rate for Payer: VA VA |
$1,441.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,325.54
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$886.18 |
| Max. Negotiated Rate |
$1,307.70 |
| Rate for Payer: Aetna Commercial |
$1,235.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.88
|
| Rate for Payer: BCN Commercial |
$1,122.88
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.40
|
| Rate for Payer: Healthscope Commercial |
$1,307.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
| Rate for Payer: PHP Commercial |
$1,235.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$886.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,278.64
|
| Rate for Payer: UHC Core |
$1,213.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.75
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$345.09 |
| Max. Negotiated Rate |
$1,307.70 |
| Rate for Payer: Aetna Commercial |
$1,235.05
|
| Rate for Payer: Aetna Medicare |
$377.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$454.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$454.06
|
| Rate for Payer: BCBS Complete |
$581.20
|
| Rate for Payer: BCBS MAPPO |
$363.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.71
|
| Rate for Payer: BCN Commercial |
$1,129.71
|
| Rate for Payer: BCN Medicare Advantage |
$363.25
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.25
|
| Rate for Payer: Healthscope Commercial |
$1,307.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$381.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$417.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
| Rate for Payer: PACE Senior Care Partners |
$345.09
|
| Rate for Payer: PACE SWMI |
$363.25
|
| Rate for Payer: PHP Commercial |
$1,235.05
|
| Rate for Payer: PHP Medicare Advantage |
$363.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.11
|
| Rate for Payer: Priority Health Medicare |
$363.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$886.18
|
| Rate for Payer: Railroad Medicare Medicare |
$363.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,278.64
|
| Rate for Payer: UHC Core |
$1,213.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.25
|
| Rate for Payer: UHC Medicare Advantage |
$374.15
|
| Rate for Payer: VA VA |
$363.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.75
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.67 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: BCBS Trust/PPO |
$208.66
|
| Rate for Payer: BCN Commercial |
$208.66
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.00
|
| Rate for Payer: Healthscope Commercial |
$243.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
| Rate for Payer: PHP Commercial |
$229.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.60
|
| Rate for Payer: UHC Core |
$225.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.50
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.38
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$67.50
|
| Rate for Payer: BCBS Trust/PPO |
$209.92
|
| Rate for Payer: BCN Commercial |
$209.92
|
| Rate for Payer: BCN Medicare Advantage |
$67.50
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.50
|
| Rate for Payer: Healthscope Commercial |
$243.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
| Rate for Payer: PACE Senior Care Partners |
$64.12
|
| Rate for Payer: PACE SWMI |
$67.50
|
| Rate for Payer: PHP Commercial |
$229.50
|
| Rate for Payer: PHP Medicare Advantage |
$67.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.90
|
| Rate for Payer: Priority Health Medicare |
$67.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.67
|
| Rate for Payer: Railroad Medicare Medicare |
$67.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.60
|
| Rate for Payer: UHC Core |
$225.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.50
|
| Rate for Payer: UHC Medicare Advantage |
$69.52
|
| Rate for Payer: VA VA |
$67.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.50
|
|
