|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna Medicare |
$65.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.05
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: BCBS MAPPO |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$196.68
|
| Rate for Payer: BCN Commercial |
$196.68
|
| Rate for Payer: BCN Medicare Advantage |
$63.24
|
| 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: Health Alliance Plan Medicare Advantage |
$63.24
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PACE Senior Care Partners |
$60.08
|
| Rate for Payer: PACE SWMI |
$63.24
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: PHP Medicare Advantage |
$63.24
|
| 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 Medicare |
$63.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.28
|
| Rate for Payer: Railroad Medicare Medicare |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.60
|
| Rate for Payer: UHC Core |
$211.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.24
|
| Rate for Payer: UHC Medicare Advantage |
$65.14
|
| Rate for Payer: VA VA |
$63.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,811.44
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,104.80 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.88
|
| Rate for Payer: BCN Commercial |
$1,399.88
|
| Rate for Payer: Cash Price |
$1,449.15
|
| Rate for Payer: Cofinity Commercial |
$1,557.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.15
|
| Rate for Payer: Healthscope Commercial |
$1,630.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.72
|
| Rate for Payer: PHP Commercial |
$1,539.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,575.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,594.07
|
| Rate for Payer: UHC Core |
$1,512.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.58
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,811.44
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$430.22 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: Aetna Medicare |
$470.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$566.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$566.08
|
| Rate for Payer: BCBS Complete |
$724.58
|
| Rate for Payer: BCBS MAPPO |
$452.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.39
|
| Rate for Payer: BCN Commercial |
$1,408.39
|
| Rate for Payer: BCN Medicare Advantage |
$452.86
|
| Rate for Payer: Cash Price |
$1,449.15
|
| Rate for Payer: Cofinity Commercial |
$1,557.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.86
|
| Rate for Payer: Healthscope Commercial |
$1,630.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$475.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$520.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.72
|
| Rate for Payer: PACE Senior Care Partners |
$430.22
|
| Rate for Payer: PACE SWMI |
$452.86
|
| Rate for Payer: PHP Commercial |
$1,539.72
|
| Rate for Payer: PHP Medicare Advantage |
$452.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,575.95
|
| Rate for Payer: Priority Health Medicare |
$452.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.80
|
| Rate for Payer: Railroad Medicare Medicare |
$452.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,594.07
|
| Rate for Payer: UHC Core |
$1,512.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.86
|
| Rate for Payer: UHC Medicare Advantage |
$466.45
|
| Rate for Payer: VA VA |
$452.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.58
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$816.74
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.98 |
| Max. Negotiated Rate |
$735.07 |
| Rate for Payer: Aetna Commercial |
$694.23
|
| Rate for Payer: Aetna Medicare |
$212.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.23
|
| Rate for Payer: BCBS Complete |
$326.70
|
| Rate for Payer: BCBS MAPPO |
$204.18
|
| Rate for Payer: BCBS Trust/PPO |
$635.02
|
| Rate for Payer: BCN Commercial |
$635.02
|
| Rate for Payer: BCN Medicare Advantage |
$204.18
|
| Rate for Payer: Cash Price |
$653.39
|
| Rate for Payer: Cofinity Commercial |
$702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.18
|
| Rate for Payer: Healthscope Commercial |
$735.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.23
|
| Rate for Payer: PACE Senior Care Partners |
$193.98
|
| Rate for Payer: PACE SWMI |
$204.18
|
| Rate for Payer: PHP Commercial |
$694.23
|
| Rate for Payer: PHP Medicare Advantage |
$204.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.56
|
| Rate for Payer: Priority Health Medicare |
$204.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.13
|
| Rate for Payer: Railroad Medicare Medicare |
$204.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.73
|
| Rate for Payer: UHC Core |
$681.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.18
|
| Rate for Payer: UHC Medicare Advantage |
$210.31
|
| Rate for Payer: VA VA |
$204.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.56
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$816.74
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$498.13 |
| Max. Negotiated Rate |
$735.07 |
| Rate for Payer: Aetna Commercial |
$694.23
|
| Rate for Payer: BCBS Trust/PPO |
$631.18
|
| Rate for Payer: BCN Commercial |
$631.18
|
| Rate for Payer: Cash Price |
$653.39
|
| Rate for Payer: Cofinity Commercial |
$702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.39
|
| Rate for Payer: Healthscope Commercial |
$735.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.23
|
| Rate for Payer: PHP Commercial |
$694.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.73
|
| Rate for Payer: UHC Core |
$681.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.56
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$939.18
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$845.26 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Medicare |
$244.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.49
|
| Rate for Payer: BCBS Complete |
$375.67
|
| Rate for Payer: BCBS MAPPO |
$234.80
|
| Rate for Payer: BCBS Trust/PPO |
$730.21
|
| Rate for Payer: BCN Commercial |
$730.21
|
| Rate for Payer: BCN Medicare Advantage |
$234.80
|
| Rate for Payer: Cash Price |
$751.34
|
| Rate for Payer: Cofinity Commercial |
$807.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.80
|
| Rate for Payer: Healthscope Commercial |
$845.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.30
|
| Rate for Payer: PACE Senior Care Partners |
$223.06
|
| Rate for Payer: PACE SWMI |
$234.80
|
| Rate for Payer: PHP Commercial |
$798.30
|
| Rate for Payer: PHP Medicare Advantage |
$234.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.09
|
| Rate for Payer: Priority Health Medicare |
$234.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.81
|
| Rate for Payer: Railroad Medicare Medicare |
$234.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.48
|
| Rate for Payer: UHC Core |
$784.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.80
|
| Rate for Payer: UHC Medicare Advantage |
$241.84
|
| Rate for Payer: VA VA |
$234.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.38
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$939.18
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.81 |
| Max. Negotiated Rate |
$845.26 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: BCBS Trust/PPO |
$725.80
|
| Rate for Payer: BCN Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$751.34
|
| Rate for Payer: Cofinity Commercial |
$807.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.34
|
| Rate for Payer: Healthscope Commercial |
$845.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.30
|
| Rate for Payer: PHP Commercial |
$798.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.48
|
| Rate for Payer: UHC Core |
$784.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.38
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,873.55
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,157.47 |
| Max. Negotiated Rate |
$4,386.20 |
| Rate for Payer: Aetna Commercial |
$4,142.52
|
| Rate for Payer: Aetna Medicare |
$1,267.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,522.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,522.98
|
| Rate for Payer: BCBS Complete |
$1,949.42
|
| Rate for Payer: BCBS MAPPO |
$1,218.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,789.19
|
| Rate for Payer: BCN Commercial |
$3,789.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.39
|
| Rate for Payer: Cash Price |
$3,898.84
|
| Rate for Payer: Cofinity Commercial |
$4,191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,898.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.39
|
| Rate for Payer: Healthscope Commercial |
$4,386.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,655.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,279.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,401.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,142.52
|
| Rate for Payer: PACE Senior Care Partners |
$1,157.47
|
| Rate for Payer: PACE SWMI |
$1,218.39
|
| Rate for Payer: PHP Commercial |
$4,142.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,239.99
|
| Rate for Payer: Priority Health Medicare |
$1,218.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,972.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,218.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,288.72
|
| Rate for Payer: UHC Core |
$4,069.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,254.94
|
| Rate for Payer: VA VA |
$1,218.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,655.16
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,873.55
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,972.38 |
| Max. Negotiated Rate |
$4,386.20 |
| Rate for Payer: Aetna Commercial |
$4,142.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,766.28
|
| Rate for Payer: BCN Commercial |
$3,766.28
|
| Rate for Payer: Cash Price |
$3,898.84
|
| Rate for Payer: Cofinity Commercial |
$4,191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,898.84
|
| Rate for Payer: Healthscope Commercial |
$4,386.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,655.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,142.52
|
| Rate for Payer: PHP Commercial |
$4,142.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,239.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,972.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,288.72
|
| Rate for Payer: UHC Core |
$4,069.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,655.16
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,358.21
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.57 |
| Max. Negotiated Rate |
$1,222.39 |
| Rate for Payer: Aetna Commercial |
$1,154.48
|
| Rate for Payer: Aetna Medicare |
$353.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$424.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$424.44
|
| Rate for Payer: BCBS Complete |
$543.28
|
| Rate for Payer: BCBS MAPPO |
$339.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.01
|
| Rate for Payer: BCN Commercial |
$1,056.01
|
| Rate for Payer: BCN Medicare Advantage |
$339.55
|
| Rate for Payer: Cash Price |
$1,086.57
|
| Rate for Payer: Cofinity Commercial |
$1,168.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.55
|
| Rate for Payer: Healthscope Commercial |
$1,222.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,154.48
|
| Rate for Payer: PACE Senior Care Partners |
$322.57
|
| Rate for Payer: PACE SWMI |
$339.55
|
| Rate for Payer: PHP Commercial |
$1,154.48
|
| Rate for Payer: PHP Medicare Advantage |
$339.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.64
|
| Rate for Payer: Priority Health Medicare |
$339.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$828.37
|
| Rate for Payer: Railroad Medicare Medicare |
$339.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,195.22
|
| Rate for Payer: UHC Core |
$1,134.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.55
|
| Rate for Payer: UHC Medicare Advantage |
$349.74
|
| Rate for Payer: VA VA |
$339.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.66
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,358.21
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.37 |
| Max. Negotiated Rate |
$1,222.39 |
| Rate for Payer: Aetna Commercial |
$1,154.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.62
|
| Rate for Payer: BCN Commercial |
$1,049.62
|
| Rate for Payer: Cash Price |
$1,086.57
|
| Rate for Payer: Cofinity Commercial |
$1,168.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.57
|
| Rate for Payer: Healthscope Commercial |
$1,222.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,154.48
|
| Rate for Payer: PHP Commercial |
$1,154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$828.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,195.22
|
| Rate for Payer: UHC Core |
$1,134.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.66
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,597.90
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.50 |
| Max. Negotiated Rate |
$1,438.11 |
| Rate for Payer: Aetna Commercial |
$1,358.22
|
| Rate for Payer: Aetna Medicare |
$415.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$499.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$499.34
|
| Rate for Payer: BCBS Complete |
$639.16
|
| Rate for Payer: BCBS MAPPO |
$399.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.37
|
| Rate for Payer: BCN Commercial |
$1,242.37
|
| Rate for Payer: BCN Medicare Advantage |
$399.48
|
| Rate for Payer: Cash Price |
$1,278.32
|
| Rate for Payer: Cofinity Commercial |
$1,374.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,278.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.48
|
| Rate for Payer: Healthscope Commercial |
$1,438.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,198.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$459.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,358.22
|
| Rate for Payer: PACE Senior Care Partners |
$379.50
|
| Rate for Payer: PACE SWMI |
$399.48
|
| Rate for Payer: PHP Commercial |
$1,358.22
|
| Rate for Payer: PHP Medicare Advantage |
$399.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,390.17
|
| Rate for Payer: Priority Health Medicare |
$399.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.56
|
| Rate for Payer: Railroad Medicare Medicare |
$399.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,406.15
|
| Rate for Payer: UHC Core |
$1,334.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.48
|
| Rate for Payer: UHC Medicare Advantage |
$411.46
|
| Rate for Payer: VA VA |
$399.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,198.42
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,597.90
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$974.56 |
| Max. Negotiated Rate |
$1,438.11 |
| Rate for Payer: Aetna Commercial |
$1,358.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.86
|
| Rate for Payer: BCN Commercial |
$1,234.86
|
| Rate for Payer: Cash Price |
$1,278.32
|
| Rate for Payer: Cofinity Commercial |
$1,374.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,278.32
|
| Rate for Payer: Healthscope Commercial |
$1,438.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,198.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,358.22
|
| Rate for Payer: PHP Commercial |
$1,358.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,390.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,406.15
|
| Rate for Payer: UHC Core |
$1,334.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,198.42
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$198.85
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$178.96 |
| Rate for Payer: Aetna Commercial |
$169.02
|
| Rate for Payer: BCBS Trust/PPO |
$153.67
|
| Rate for Payer: BCN Commercial |
$153.67
|
| Rate for Payer: Cash Price |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$171.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.08
|
| Rate for Payer: Healthscope Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.02
|
| Rate for Payer: PHP Commercial |
$169.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.99
|
| Rate for Payer: UHC Core |
$166.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.14
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$198.85
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$178.96 |
| Rate for Payer: Aetna Commercial |
$169.02
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.14
|
| Rate for Payer: BCBS Complete |
$79.54
|
| Rate for Payer: BCBS MAPPO |
$49.71
|
| Rate for Payer: BCBS Trust/PPO |
$154.61
|
| Rate for Payer: BCN Commercial |
$154.61
|
| Rate for Payer: BCN Medicare Advantage |
$49.71
|
| Rate for Payer: Cash Price |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$171.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.71
|
| Rate for Payer: Healthscope Commercial |
$178.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.02
|
| Rate for Payer: PACE Senior Care Partners |
$47.23
|
| Rate for Payer: PACE SWMI |
$49.71
|
| Rate for Payer: PHP Commercial |
$169.02
|
| Rate for Payer: PHP Medicare Advantage |
$49.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.00
|
| Rate for Payer: Priority Health Medicare |
$49.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.28
|
| Rate for Payer: Railroad Medicare Medicare |
$49.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.99
|
| Rate for Payer: UHC Core |
$166.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.71
|
| Rate for Payer: UHC Medicare Advantage |
$51.20
|
| Rate for Payer: VA VA |
$49.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.14
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$389.73 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna Commercial |
$543.15
|
| Rate for Payer: BCBS Trust/PPO |
$493.82
|
| Rate for Payer: BCN Commercial |
$493.82
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$549.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.20
|
| Rate for Payer: Healthscope Commercial |
$575.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$543.15
|
| Rate for Payer: PHP Commercial |
$543.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.32
|
| Rate for Payer: UHC Core |
$533.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$479.25
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna Commercial |
$543.15
|
| Rate for Payer: Aetna Medicare |
$166.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.69
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS MAPPO |
$159.75
|
| Rate for Payer: BCBS Trust/PPO |
$496.82
|
| Rate for Payer: BCN Commercial |
$496.82
|
| Rate for Payer: BCN Medicare Advantage |
$159.75
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$549.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.75
|
| Rate for Payer: Healthscope Commercial |
$575.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$479.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$543.15
|
| Rate for Payer: PACE Senior Care Partners |
$151.76
|
| Rate for Payer: PACE SWMI |
$159.75
|
| Rate for Payer: PHP Commercial |
$543.15
|
| Rate for Payer: PHP Medicare Advantage |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.93
|
| Rate for Payer: Priority Health Medicare |
$159.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.73
|
| Rate for Payer: Railroad Medicare Medicare |
$159.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.32
|
| Rate for Payer: UHC Core |
$533.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.75
|
| Rate for Payer: UHC Medicare Advantage |
$164.54
|
| Rate for Payer: VA VA |
$159.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$479.25
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: BCBS Trust/PPO |
$140.65
|
| Rate for Payer: BCN Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.16
|
| Rate for Payer: UHC Core |
$151.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.88
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$45.50
|
| Rate for Payer: BCBS Trust/PPO |
$141.50
|
| Rate for Payer: BCN Commercial |
$141.50
|
| Rate for Payer: BCN Medicare Advantage |
$45.50
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.50
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: PACE Senior Care Partners |
$43.22
|
| Rate for Payer: PACE SWMI |
$45.50
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: PHP Medicare Advantage |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.34
|
| Rate for Payer: Priority Health Medicare |
$45.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.00
|
| Rate for Payer: Railroad Medicare Medicare |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.16
|
| Rate for Payer: UHC Core |
$151.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.50
|
| Rate for Payer: UHC Medicare Advantage |
$46.86
|
| Rate for Payer: VA VA |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$191.10
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: BCBS Trust/PPO |
$147.68
|
| Rate for Payer: BCN Commercial |
$147.68
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.44
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.17
|
| Rate for Payer: UHC Core |
$159.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$191.10
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: Aetna Medicare |
$49.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.72
|
| Rate for Payer: BCBS Complete |
$76.44
|
| Rate for Payer: BCBS MAPPO |
$47.78
|
| Rate for Payer: BCBS Trust/PPO |
$148.58
|
| Rate for Payer: BCN Commercial |
$148.58
|
| Rate for Payer: BCN Medicare Advantage |
$47.78
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.78
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.44
|
| Rate for Payer: PACE Senior Care Partners |
$45.39
|
| Rate for Payer: PACE SWMI |
$47.78
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: PHP Medicare Advantage |
$47.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.26
|
| Rate for Payer: Priority Health Medicare |
$47.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: Railroad Medicare Medicare |
$47.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.17
|
| Rate for Payer: UHC Core |
$159.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.78
|
| Rate for Payer: UHC Medicare Advantage |
$49.21
|
| Rate for Payer: VA VA |
$47.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,504.42
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$594.80 |
| Max. Negotiated Rate |
$2,253.98 |
| Rate for Payer: Aetna Commercial |
$2,128.76
|
| Rate for Payer: Aetna Medicare |
$651.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.63
|
| Rate for Payer: BCBS Complete |
$1,001.77
|
| Rate for Payer: BCBS MAPPO |
$626.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,947.19
|
| Rate for Payer: BCN Commercial |
$1,947.19
|
| Rate for Payer: BCN Medicare Advantage |
$626.10
|
| Rate for Payer: Cash Price |
$2,003.54
|
| Rate for Payer: Cofinity Commercial |
$2,153.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,003.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.10
|
| Rate for Payer: Healthscope Commercial |
$2,253.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,878.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$720.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,128.76
|
| Rate for Payer: PACE Senior Care Partners |
$594.80
|
| Rate for Payer: PACE SWMI |
$626.10
|
| Rate for Payer: PHP Commercial |
$2,128.76
|
| Rate for Payer: PHP Medicare Advantage |
$626.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,178.85
|
| Rate for Payer: Priority Health Medicare |
$626.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,527.45
|
| Rate for Payer: Railroad Medicare Medicare |
$626.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,203.89
|
| Rate for Payer: UHC Core |
$2,091.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.10
|
| Rate for Payer: UHC Medicare Advantage |
$644.89
|
| Rate for Payer: VA VA |
$626.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,878.32
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,504.42
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,527.45 |
| Max. Negotiated Rate |
$2,253.98 |
| Rate for Payer: Aetna Commercial |
$2,128.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.42
|
| Rate for Payer: BCN Commercial |
$1,935.42
|
| Rate for Payer: Cash Price |
$2,003.54
|
| Rate for Payer: Cofinity Commercial |
$2,153.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,003.54
|
| Rate for Payer: Healthscope Commercial |
$2,253.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,878.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,128.76
|
| Rate for Payer: PHP Commercial |
$2,128.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,178.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,527.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,203.89
|
| Rate for Payer: UHC Core |
$2,091.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,878.32
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,665.96
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,625.97 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,266.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,060.25
|
| Rate for Payer: BCN Commercial |
$2,060.25
|
| Rate for Payer: Cash Price |
$2,132.77
|
| Rate for Payer: Cofinity Commercial |
$2,292.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.77
|
| Rate for Payer: Healthscope Commercial |
$2,399.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,266.07
|
| Rate for Payer: PHP Commercial |
$2,266.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,319.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,625.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,346.04
|
| Rate for Payer: UHC Core |
$2,226.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.47
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,665.96
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$633.17 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,266.07
|
| Rate for Payer: Aetna Medicare |
$693.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$833.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$833.11
|
| Rate for Payer: BCBS Complete |
$1,066.38
|
| Rate for Payer: BCBS MAPPO |
$666.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.78
|
| Rate for Payer: BCN Commercial |
$2,072.78
|
| Rate for Payer: BCN Medicare Advantage |
$666.49
|
| Rate for Payer: Cash Price |
$2,132.77
|
| Rate for Payer: Cofinity Commercial |
$2,292.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$666.49
|
| Rate for Payer: Healthscope Commercial |
$2,399.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$699.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$766.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,266.07
|
| Rate for Payer: PACE Senior Care Partners |
$633.17
|
| Rate for Payer: PACE SWMI |
$666.49
|
| Rate for Payer: PHP Commercial |
$2,266.07
|
| Rate for Payer: PHP Medicare Advantage |
$666.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,319.39
|
| Rate for Payer: Priority Health Medicare |
$666.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,625.97
|
| Rate for Payer: Railroad Medicare Medicare |
$666.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,346.04
|
| Rate for Payer: UHC Core |
$2,226.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$666.49
|
| Rate for Payer: UHC Medicare Advantage |
$686.48
|
| Rate for Payer: VA VA |
$666.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.47
|
|
