|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$364.52
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.57 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$309.84
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.91
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$283.41
|
| Rate for Payer: BCN Commercial |
$283.41
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.84
|
| Rate for Payer: PACE Senior Care Partners |
$86.57
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.84
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.13
|
| Rate for Payer: Priority Health Medicare |
$91.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.32
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.78
|
| Rate for Payer: UHC Core |
$304.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.13
|
| Rate for Payer: UHC Medicare Advantage |
$93.86
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.39
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$364.52
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$222.32 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$309.84
|
| Rate for Payer: BCBS Trust/PPO |
$281.70
|
| Rate for Payer: BCN Commercial |
$281.70
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.84
|
| Rate for Payer: PHP Commercial |
$309.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.78
|
| Rate for Payer: UHC Core |
$304.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.39
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$330.90
|
| Rate for Payer: BCBS Trust/PPO |
$300.85
|
| Rate for Payer: BCN Commercial |
$300.85
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: PHP Commercial |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.58
|
| Rate for Payer: UHC Core |
$325.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.98
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.46 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$330.90
|
| Rate for Payer: Aetna Medicare |
$101.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.66
|
| Rate for Payer: BCBS Complete |
$155.72
|
| Rate for Payer: BCBS MAPPO |
$97.32
|
| Rate for Payer: BCBS Trust/PPO |
$302.68
|
| Rate for Payer: BCN Commercial |
$302.68
|
| Rate for Payer: BCN Medicare Advantage |
$97.32
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.32
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: PACE Senior Care Partners |
$92.46
|
| Rate for Payer: PACE SWMI |
$97.32
|
| Rate for Payer: PHP Commercial |
$330.90
|
| Rate for Payer: PHP Medicare Advantage |
$97.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.69
|
| Rate for Payer: Priority Health Medicare |
$97.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.43
|
| Rate for Payer: Railroad Medicare Medicare |
$97.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.58
|
| Rate for Payer: UHC Core |
$325.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.32
|
| Rate for Payer: UHC Medicare Advantage |
$100.24
|
| Rate for Payer: VA VA |
$97.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.98
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$261.18 |
| Max. Negotiated Rate |
$385.41 |
| Rate for Payer: Aetna Commercial |
$364.00
|
| Rate for Payer: BCBS Trust/PPO |
$330.94
|
| Rate for Payer: BCN Commercial |
$330.94
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$368.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Healthscope Commercial |
$385.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: PHP Commercial |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.84
|
| Rate for Payer: UHC Core |
$357.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.17
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$385.41 |
| Rate for Payer: Aetna Commercial |
$364.00
|
| Rate for Payer: Aetna Medicare |
$111.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.82
|
| Rate for Payer: BCBS Complete |
$171.29
|
| Rate for Payer: BCBS MAPPO |
$107.06
|
| Rate for Payer: BCBS Trust/PPO |
$332.95
|
| Rate for Payer: BCN Commercial |
$332.95
|
| Rate for Payer: BCN Medicare Advantage |
$107.06
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$368.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.06
|
| Rate for Payer: Healthscope Commercial |
$385.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: PACE Senior Care Partners |
$101.70
|
| Rate for Payer: PACE SWMI |
$107.06
|
| Rate for Payer: PHP Commercial |
$364.00
|
| Rate for Payer: PHP Medicare Advantage |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.56
|
| Rate for Payer: Priority Health Medicare |
$107.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.18
|
| Rate for Payer: Railroad Medicare Medicare |
$107.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.84
|
| Rate for Payer: UHC Core |
$357.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.06
|
| Rate for Payer: UHC Medicare Advantage |
$110.27
|
| Rate for Payer: VA VA |
$107.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.17
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.37 |
| Max. Negotiated Rate |
$475.10 |
| Rate for Payer: Aetna Commercial |
$448.71
|
| Rate for Payer: Aetna Medicare |
$137.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.97
|
| Rate for Payer: BCBS Complete |
$211.16
|
| Rate for Payer: BCBS MAPPO |
$131.97
|
| Rate for Payer: BCBS Trust/PPO |
$410.43
|
| Rate for Payer: BCN Commercial |
$410.43
|
| Rate for Payer: BCN Medicare Advantage |
$131.97
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.97
|
| Rate for Payer: Healthscope Commercial |
$475.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: PACE Senior Care Partners |
$125.37
|
| Rate for Payer: PACE SWMI |
$131.97
|
| Rate for Payer: PHP Commercial |
$448.71
|
| Rate for Payer: PHP Medicare Advantage |
$131.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.26
|
| Rate for Payer: Priority Health Medicare |
$131.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.96
|
| Rate for Payer: Railroad Medicare Medicare |
$131.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.54
|
| Rate for Payer: UHC Core |
$440.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.97
|
| Rate for Payer: UHC Medicare Advantage |
$135.93
|
| Rate for Payer: VA VA |
$131.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.92
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.96 |
| Max. Negotiated Rate |
$475.10 |
| Rate for Payer: Aetna Commercial |
$448.71
|
| Rate for Payer: BCBS Trust/PPO |
$407.95
|
| Rate for Payer: BCN Commercial |
$407.95
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Healthscope Commercial |
$475.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: PHP Commercial |
$448.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.54
|
| Rate for Payer: UHC Core |
$440.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.92
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$163.29 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Medicare |
$47.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.70
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS MAPPO |
$45.36
|
| Rate for Payer: BCBS Trust/PPO |
$141.06
|
| Rate for Payer: BCN Commercial |
$141.06
|
| Rate for Payer: BCN Medicare Advantage |
$45.36
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.36
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: PACE Senior Care Partners |
$43.09
|
| Rate for Payer: PACE SWMI |
$45.36
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: PHP Medicare Advantage |
$45.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.84
|
| Rate for Payer: Priority Health Medicare |
$45.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.65
|
| Rate for Payer: Railroad Medicare Medicare |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.66
|
| Rate for Payer: UHC Core |
$151.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.36
|
| Rate for Payer: UHC Medicare Advantage |
$46.72
|
| Rate for Payer: VA VA |
$45.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.07
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$163.29 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: BCBS Trust/PPO |
$140.21
|
| Rate for Payer: BCN Commercial |
$140.21
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.66
|
| Rate for Payer: UHC Core |
$151.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.07
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.24 |
| Max. Negotiated Rate |
$474.61 |
| Rate for Payer: Aetna Commercial |
$448.24
|
| Rate for Payer: Aetna Medicare |
$137.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.79
|
| Rate for Payer: BCBS Complete |
$210.94
|
| Rate for Payer: BCBS MAPPO |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$410.01
|
| Rate for Payer: BCN Commercial |
$410.01
|
| Rate for Payer: BCN Medicare Advantage |
$131.84
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cofinity Commercial |
$453.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.84
|
| Rate for Payer: Healthscope Commercial |
$474.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.24
|
| Rate for Payer: PACE Senior Care Partners |
$125.24
|
| Rate for Payer: PACE SWMI |
$131.84
|
| Rate for Payer: PHP Commercial |
$448.24
|
| Rate for Payer: PHP Medicare Advantage |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.79
|
| Rate for Payer: Priority Health Medicare |
$131.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.62
|
| Rate for Payer: Railroad Medicare Medicare |
$131.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.06
|
| Rate for Payer: UHC Core |
$440.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.84
|
| Rate for Payer: UHC Medicare Advantage |
$135.79
|
| Rate for Payer: VA VA |
$131.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.50
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$474.61 |
| Rate for Payer: Aetna Commercial |
$448.24
|
| Rate for Payer: BCBS Trust/PPO |
$407.53
|
| Rate for Payer: BCN Commercial |
$407.53
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cofinity Commercial |
$453.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.87
|
| Rate for Payer: Healthscope Commercial |
$474.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.24
|
| Rate for Payer: PHP Commercial |
$448.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.06
|
| Rate for Payer: UHC Core |
$440.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.50
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$49.33
|
| Rate for Payer: BCBS Trust/PPO |
$44.85
|
| Rate for Payer: BCN Commercial |
$44.85
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$49.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: PHP Commercial |
$49.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.08
|
| Rate for Payer: UHC Core |
$48.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.53
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$49.33
|
| Rate for Payer: Aetna Medicare |
$15.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.14
|
| Rate for Payer: BCBS Complete |
$23.22
|
| Rate for Payer: BCBS MAPPO |
$14.51
|
| Rate for Payer: BCBS Trust/PPO |
$45.13
|
| Rate for Payer: BCN Commercial |
$45.13
|
| Rate for Payer: BCN Medicare Advantage |
$14.51
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$49.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.51
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: PACE Senior Care Partners |
$13.78
|
| Rate for Payer: PACE SWMI |
$14.51
|
| Rate for Payer: PHP Commercial |
$49.33
|
| Rate for Payer: PHP Medicare Advantage |
$14.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.49
|
| Rate for Payer: Priority Health Medicare |
$14.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.08
|
| Rate for Payer: UHC Core |
$48.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.51
|
| Rate for Payer: UHC Medicare Advantage |
$14.95
|
| Rate for Payer: VA VA |
$14.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.53
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: Aetna Medicare |
$80.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.71
|
| Rate for Payer: BCBS Complete |
$123.79
|
| Rate for Payer: BCBS MAPPO |
$77.37
|
| Rate for Payer: BCBS Trust/PPO |
$240.61
|
| Rate for Payer: BCN Commercial |
$240.61
|
| Rate for Payer: BCN Medicare Advantage |
$77.37
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.37
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: PACE Senior Care Partners |
$73.50
|
| Rate for Payer: PACE SWMI |
$77.37
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: PHP Medicare Advantage |
$77.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.24
|
| Rate for Payer: Priority Health Medicare |
$77.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.75
|
| Rate for Payer: Railroad Medicare Medicare |
$77.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.33
|
| Rate for Payer: UHC Core |
$258.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.37
|
| Rate for Payer: UHC Medicare Advantage |
$79.69
|
| Rate for Payer: VA VA |
$77.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.75 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: BCBS Trust/PPO |
$239.16
|
| Rate for Payer: BCN Commercial |
$239.16
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.33
|
| Rate for Payer: UHC Core |
$258.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: BCBS Trust/PPO |
$119.03
|
| Rate for Payer: BCN Commercial |
$119.03
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.54
|
| Rate for Payer: UHC Core |
$128.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.13
|
| Rate for Payer: BCBS Complete |
$61.61
|
| Rate for Payer: BCBS MAPPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$119.75
|
| Rate for Payer: BCN Commercial |
$119.75
|
| Rate for Payer: BCN Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.50
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: PACE Senior Care Partners |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.50
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: PHP Medicare Advantage |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.00
|
| Rate for Payer: Priority Health Medicare |
$38.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.94
|
| Rate for Payer: Railroad Medicare Medicare |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.54
|
| Rate for Payer: UHC Core |
$128.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.50
|
| Rate for Payer: UHC Medicare Advantage |
$39.66
|
| Rate for Payer: VA VA |
$38.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.09 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$92.11
|
| Rate for Payer: BCBS Trust/PPO |
$83.74
|
| Rate for Payer: BCN Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: PHP Commercial |
$92.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.36
|
| Rate for Payer: UHC Core |
$90.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.27
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$92.11
|
| Rate for Payer: Aetna Medicare |
$28.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.86
|
| Rate for Payer: BCBS Complete |
$43.34
|
| Rate for Payer: BCBS MAPPO |
$27.09
|
| Rate for Payer: BCBS Trust/PPO |
$84.25
|
| Rate for Payer: BCN Commercial |
$84.25
|
| Rate for Payer: BCN Medicare Advantage |
$27.09
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.09
|
| Rate for Payer: Healthscope Commercial |
$97.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: PACE Senior Care Partners |
$25.74
|
| Rate for Payer: PACE SWMI |
$27.09
|
| Rate for Payer: PHP Commercial |
$92.11
|
| Rate for Payer: PHP Medicare Advantage |
$27.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.27
|
| Rate for Payer: Priority Health Medicare |
$27.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.09
|
| Rate for Payer: Railroad Medicare Medicare |
$27.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.36
|
| Rate for Payer: UHC Core |
$90.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.09
|
| Rate for Payer: UHC Medicare Advantage |
$27.90
|
| Rate for Payer: VA VA |
$27.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.27
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$86.84 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: BCBS Trust/PPO |
$74.57
|
| Rate for Payer: BCN Commercial |
$74.57
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$82.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$86.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: PHP Commercial |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.91
|
| Rate for Payer: UHC Core |
$80.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.37
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$86.84 |
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna Medicare |
$25.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.15
|
| Rate for Payer: BCBS Complete |
$38.60
|
| Rate for Payer: BCBS MAPPO |
$24.12
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: BCN Commercial |
$75.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.12
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$82.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$86.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: PACE Senior Care Partners |
$22.92
|
| Rate for Payer: PACE SWMI |
$24.12
|
| Rate for Payer: PHP Commercial |
$82.02
|
| Rate for Payer: PHP Medicare Advantage |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.95
|
| Rate for Payer: Priority Health Medicare |
$24.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.85
|
| Rate for Payer: Railroad Medicare Medicare |
$24.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.91
|
| Rate for Payer: UHC Core |
$80.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.12
|
| Rate for Payer: UHC Medicare Advantage |
$24.85
|
| Rate for Payer: VA VA |
$24.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.37
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: Aetna Medicare |
$832.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,000.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,000.00
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS MAPPO |
$800.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,488.00
|
| Rate for Payer: BCN Commercial |
$2,488.00
|
| Rate for Payer: BCN Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$840.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PACE Senior Care Partners |
$760.00
|
| Rate for Payer: PACE SWMI |
$800.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: PHP Medicare Advantage |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,784.00
|
| Rate for Payer: Priority Health Medicare |
$800.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,951.68
|
| Rate for Payer: Railroad Medicare Medicare |
$800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,816.00
|
| Rate for Payer: UHC Core |
$2,672.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.00
|
| Rate for Payer: UHC Medicare Advantage |
$824.00
|
| Rate for Payer: VA VA |
$800.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,951.68 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,472.96
|
| Rate for Payer: BCN Commercial |
$2,472.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,784.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,951.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,816.00
|
| Rate for Payer: UHC Core |
$2,672.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$702.41 |
| Max. Negotiated Rate |
$2,661.78 |
| Rate for Payer: Aetna Commercial |
$2,513.90
|
| Rate for Payer: Aetna Medicare |
$768.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$924.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$924.23
|
| Rate for Payer: BCBS Complete |
$1,183.01
|
| Rate for Payer: BCBS MAPPO |
$739.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.48
|
| Rate for Payer: BCN Commercial |
$2,299.48
|
| Rate for Payer: BCN Medicare Advantage |
$739.38
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,543.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.38
|
| Rate for Payer: Healthscope Commercial |
$2,661.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,218.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$776.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$850.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: PACE Senior Care Partners |
$702.41
|
| Rate for Payer: PACE SWMI |
$739.38
|
| Rate for Payer: PHP Commercial |
$2,513.90
|
| Rate for Payer: PHP Medicare Advantage |
$739.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,573.05
|
| Rate for Payer: Priority Health Medicare |
$739.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,803.80
|
| Rate for Payer: Railroad Medicare Medicare |
$739.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,602.63
|
| Rate for Payer: UHC Core |
$2,469.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.38
|
| Rate for Payer: UHC Medicare Advantage |
$761.56
|
| Rate for Payer: VA VA |
$739.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,218.15
|
|
