|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$53.32
|
| Rate for Payer: BCN Commercial |
$53.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.65
|
| Rate for Payer: BCN Commercial |
$53.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.76 |
| Max. Negotiated Rate |
$950.25 |
| Rate for Payer: Aetna Commercial |
$897.46
|
| Rate for Payer: Aetna Medicare |
$274.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.95
|
| Rate for Payer: BCBS Complete |
$422.33
|
| Rate for Payer: BCBS MAPPO |
$263.96
|
| Rate for Payer: BCBS Trust/PPO |
$820.91
|
| Rate for Payer: BCN Commercial |
$820.91
|
| Rate for Payer: BCN Medicare Advantage |
$263.96
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$908.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.96
|
| Rate for Payer: Healthscope Commercial |
$950.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$277.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: PACE Senior Care Partners |
$250.76
|
| Rate for Payer: PACE SWMI |
$263.96
|
| Rate for Payer: PHP Commercial |
$897.46
|
| Rate for Payer: PHP Medicare Advantage |
$263.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$918.57
|
| Rate for Payer: Priority Health Medicare |
$263.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.95
|
| Rate for Payer: Railroad Medicare Medicare |
$263.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.13
|
| Rate for Payer: UHC Core |
$881.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.96
|
| Rate for Payer: UHC Medicare Advantage |
$271.88
|
| Rate for Payer: VA VA |
$263.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.87
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.95 |
| Max. Negotiated Rate |
$950.25 |
| Rate for Payer: Aetna Commercial |
$897.46
|
| Rate for Payer: BCBS Trust/PPO |
$815.95
|
| Rate for Payer: BCN Commercial |
$815.95
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$908.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Healthscope Commercial |
$950.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: PHP Commercial |
$897.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$918.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.13
|
| Rate for Payer: UHC Core |
$881.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.87
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$417.78 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna Commercial |
$582.25
|
| Rate for Payer: BCBS Trust/PPO |
$529.37
|
| Rate for Payer: BCN Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$589.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Healthscope Commercial |
$616.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: PHP Commercial |
$582.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$595.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.80
|
| Rate for Payer: UHC Core |
$571.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.75
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna Commercial |
$582.25
|
| Rate for Payer: Aetna Medicare |
$178.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.06
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS MAPPO |
$171.25
|
| Rate for Payer: BCBS Trust/PPO |
$532.59
|
| Rate for Payer: BCN Commercial |
$532.59
|
| Rate for Payer: BCN Medicare Advantage |
$171.25
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$589.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.25
|
| Rate for Payer: Healthscope Commercial |
$616.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: PACE Senior Care Partners |
$162.69
|
| Rate for Payer: PACE SWMI |
$171.25
|
| Rate for Payer: PHP Commercial |
$582.25
|
| Rate for Payer: PHP Medicare Advantage |
$171.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$595.95
|
| Rate for Payer: Priority Health Medicare |
$171.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.78
|
| Rate for Payer: Railroad Medicare Medicare |
$171.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.80
|
| Rate for Payer: UHC Core |
$571.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.25
|
| Rate for Payer: UHC Medicare Advantage |
$176.39
|
| Rate for Payer: VA VA |
$171.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.75
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.91
|
| Rate for Payer: BCN Commercial |
$30.91
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$31.10
|
| Rate for Payer: BCN Commercial |
$31.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.00
|
| Rate for Payer: UHC Medicare Advantage |
$10.30
|
| Rate for Payer: VA VA |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$50.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.25
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$49.00
|
| Rate for Payer: BCBS Trust/PPO |
$152.39
|
| Rate for Payer: BCN Commercial |
$152.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.00
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.00
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: PACE Senior Care Partners |
$46.55
|
| Rate for Payer: PACE SWMI |
$49.00
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: PHP Medicare Advantage |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.52
|
| Rate for Payer: Priority Health Medicare |
$49.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.48
|
| Rate for Payer: UHC Core |
$163.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.00
|
| Rate for Payer: UHC Medicare Advantage |
$50.47
|
| Rate for Payer: VA VA |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: BCBS Trust/PPO |
$151.47
|
| Rate for Payer: BCN Commercial |
$151.47
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.48
|
| Rate for Payer: UHC Core |
$163.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$414.37
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$372.93 |
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna Medicare |
$107.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.49
|
| Rate for Payer: BCBS Complete |
$165.75
|
| Rate for Payer: BCBS MAPPO |
$103.59
|
| Rate for Payer: BCBS Trust/PPO |
$322.17
|
| Rate for Payer: BCN Commercial |
$322.17
|
| Rate for Payer: BCN Medicare Advantage |
$103.59
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.59
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
| Rate for Payer: PACE Senior Care Partners |
$98.41
|
| Rate for Payer: PACE SWMI |
$103.59
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Medicare Advantage |
$103.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.50
|
| Rate for Payer: Priority Health Medicare |
$103.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.72
|
| Rate for Payer: Railroad Medicare Medicare |
$103.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.65
|
| Rate for Payer: UHC Core |
$346.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.59
|
| Rate for Payer: UHC Medicare Advantage |
$106.70
|
| Rate for Payer: VA VA |
$103.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$414.37
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.72 |
| Max. Negotiated Rate |
$372.93 |
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: BCBS Trust/PPO |
$320.23
|
| Rate for Payer: BCN Commercial |
$320.23
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.65
|
| Rate for Payer: UHC Core |
$346.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$447.52 |
| Rate for Payer: Aetna Commercial |
$422.65
|
| Rate for Payer: Aetna Medicare |
$129.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.39
|
| Rate for Payer: BCBS Complete |
$198.90
|
| Rate for Payer: BCBS MAPPO |
$124.31
|
| Rate for Payer: BCBS Trust/PPO |
$386.60
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: BCN Medicare Advantage |
$124.31
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.31
|
| Rate for Payer: Healthscope Commercial |
$447.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: PACE Senior Care Partners |
$118.09
|
| Rate for Payer: PACE SWMI |
$124.31
|
| Rate for Payer: PHP Commercial |
$422.65
|
| Rate for Payer: PHP Medicare Advantage |
$124.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.60
|
| Rate for Payer: Priority Health Medicare |
$124.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.27
|
| Rate for Payer: Railroad Medicare Medicare |
$124.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.57
|
| Rate for Payer: UHC Core |
$415.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.31
|
| Rate for Payer: UHC Medicare Advantage |
$128.04
|
| Rate for Payer: VA VA |
$124.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.93
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.27 |
| Max. Negotiated Rate |
$447.52 |
| Rate for Payer: Aetna Commercial |
$422.65
|
| Rate for Payer: BCBS Trust/PPO |
$384.27
|
| Rate for Payer: BCN Commercial |
$384.27
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Healthscope Commercial |
$447.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: PHP Commercial |
$422.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.57
|
| Rate for Payer: UHC Core |
$415.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.93
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.31 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna Commercial |
$249.90
|
| Rate for Payer: BCBS Trust/PPO |
$227.20
|
| Rate for Payer: BCN Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$252.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Healthscope Commercial |
$264.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: PHP Commercial |
$249.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.72
|
| Rate for Payer: UHC Core |
$245.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.50
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna Commercial |
$249.90
|
| Rate for Payer: Aetna Medicare |
$76.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.88
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS MAPPO |
$73.50
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$228.58
|
| Rate for Payer: BCN Medicare Advantage |
$73.50
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$252.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$264.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: PACE Senior Care Partners |
$69.82
|
| Rate for Payer: PACE SWMI |
$73.50
|
| Rate for Payer: PHP Commercial |
$249.90
|
| Rate for Payer: PHP Medicare Advantage |
$73.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.78
|
| Rate for Payer: Priority Health Medicare |
$73.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.72
|
| Rate for Payer: UHC Core |
$245.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.50
|
| Rate for Payer: UHC Medicare Advantage |
$75.70
|
| Rate for Payer: VA VA |
$73.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.50
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$307.32 |
| Max. Negotiated Rate |
$453.49 |
| Rate for Payer: Aetna Commercial |
$428.30
|
| Rate for Payer: BCBS Trust/PPO |
$389.40
|
| Rate for Payer: BCN Commercial |
$389.40
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Healthscope Commercial |
$453.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: PHP Commercial |
$428.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.41
|
| Rate for Payer: UHC Core |
$420.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.91
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.67 |
| Max. Negotiated Rate |
$453.49 |
| Rate for Payer: Aetna Commercial |
$428.30
|
| Rate for Payer: Aetna Medicare |
$131.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.46
|
| Rate for Payer: BCBS Complete |
$201.55
|
| Rate for Payer: BCBS MAPPO |
$125.97
|
| Rate for Payer: BCBS Trust/PPO |
$391.77
|
| Rate for Payer: BCN Commercial |
$391.77
|
| Rate for Payer: BCN Medicare Advantage |
$125.97
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.97
|
| Rate for Payer: Healthscope Commercial |
$453.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: PACE Senior Care Partners |
$119.67
|
| Rate for Payer: PACE SWMI |
$125.97
|
| Rate for Payer: PHP Commercial |
$428.30
|
| Rate for Payer: PHP Medicare Advantage |
$125.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.38
|
| Rate for Payer: Priority Health Medicare |
$125.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.32
|
| Rate for Payer: Railroad Medicare Medicare |
$125.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.41
|
| Rate for Payer: UHC Core |
$420.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.97
|
| Rate for Payer: UHC Medicare Advantage |
$129.75
|
| Rate for Payer: VA VA |
$125.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.91
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$371.29 |
| Rate for Payer: Aetna Commercial |
$350.66
|
| Rate for Payer: Aetna Medicare |
$107.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.92
|
| Rate for Payer: BCBS Complete |
$165.02
|
| Rate for Payer: BCBS MAPPO |
$103.14
|
| Rate for Payer: BCBS Trust/PPO |
$320.75
|
| Rate for Payer: BCN Commercial |
$320.75
|
| Rate for Payer: BCN Medicare Advantage |
$103.14
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$354.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.14
|
| Rate for Payer: Healthscope Commercial |
$371.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: PACE Senior Care Partners |
$97.98
|
| Rate for Payer: PACE SWMI |
$103.14
|
| Rate for Payer: PHP Commercial |
$350.66
|
| Rate for Payer: PHP Medicare Advantage |
$103.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.91
|
| Rate for Payer: Priority Health Medicare |
$103.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.61
|
| Rate for Payer: Railroad Medicare Medicare |
$103.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.04
|
| Rate for Payer: UHC Core |
$344.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.14
|
| Rate for Payer: UHC Medicare Advantage |
$106.23
|
| Rate for Payer: VA VA |
$103.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.40
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$251.61 |
| Max. Negotiated Rate |
$371.29 |
| Rate for Payer: Aetna Commercial |
$350.66
|
| Rate for Payer: BCBS Trust/PPO |
$318.81
|
| Rate for Payer: BCN Commercial |
$318.81
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$354.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Healthscope Commercial |
$371.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: PHP Commercial |
$350.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.04
|
| Rate for Payer: UHC Core |
$344.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.40
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.95
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.78 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.10
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$97.19
|
| Rate for Payer: BCN Commercial |
$97.19
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.25
|
| Rate for Payer: UHC Medicare Advantage |
$32.19
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.60
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: BCBS Trust/PPO |
$195.49
|
| Rate for Payer: BCN Commercial |
$195.49
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.60
|
| Rate for Payer: UHC Core |
$211.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
