|
HC BRACE AFO
|
Facility
|
OP
|
$608.06
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$547.25 |
| Rate for Payer: Aetna Commercial |
$516.85
|
| Rate for Payer: Aetna Medicare |
$158.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.02
|
| Rate for Payer: BCBS Complete |
$112.55
|
| Rate for Payer: BCBS MAPPO |
$152.01
|
| Rate for Payer: BCBS Trust/PPO |
$499.89
|
| Rate for Payer: BCN Commercial |
$499.89
|
| Rate for Payer: BCN Medicare Advantage |
$152.01
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cofinity Commercial |
$522.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.01
|
| Rate for Payer: Healthscope Commercial |
$547.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$456.05
|
| Rate for Payer: Mclaren Medicaid |
$107.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.62
|
| Rate for Payer: Meridian Medicaid |
$112.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.85
|
| Rate for Payer: Nomi Health Commercial |
$498.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.05
|
| Rate for Payer: PACE Senior Care Partners |
$144.41
|
| Rate for Payer: PACE SWMI |
$152.01
|
| Rate for Payer: PHP Commercial |
$516.85
|
| Rate for Payer: PHP Medicare Advantage |
$152.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$529.01
|
| Rate for Payer: Priority Health Medicare |
$153.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$423.21
|
| Rate for Payer: Railroad Medicare Medicare |
$152.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.09
|
| Rate for Payer: UHC Core |
$507.73
|
| Rate for Payer: UHC Exchange |
$152.01
|
| Rate for Payer: UHC Medicaid |
$107.20
|
| Rate for Payer: UHC Medicare Advantage |
$152.01
|
| Rate for Payer: UHCCP Medicaid |
$107.20
|
| Rate for Payer: VA VA |
$152.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$456.05
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,041.26 |
| Max. Negotiated Rate |
$1,346.45 |
| Rate for Payer: Aetna Commercial |
$1,271.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.60
|
| Rate for Payer: BCN Commercial |
$1,235.60
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Commercial |
$1,286.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Healthscope Commercial |
$1,346.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,122.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Nomi Health Commercial |
$1,226.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: PHP Commercial |
$1,271.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,301.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,041.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.53
|
| Rate for Payer: UHC Core |
$1,249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,122.05
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,496.06
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.76 |
| Max. Negotiated Rate |
$1,346.45 |
| Rate for Payer: Aetna Commercial |
$1,271.65
|
| Rate for Payer: Aetna Medicare |
$388.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.52
|
| Rate for Payer: BCBS Complete |
$276.92
|
| Rate for Payer: BCBS MAPPO |
$374.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.91
|
| Rate for Payer: BCN Commercial |
$1,229.91
|
| Rate for Payer: BCN Medicare Advantage |
$374.01
|
| Rate for Payer: Cash Price |
$1,196.85
|
| Rate for Payer: Cofinity Commercial |
$1,286.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.01
|
| Rate for Payer: Healthscope Commercial |
$1,346.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,122.05
|
| Rate for Payer: Mclaren Medicaid |
$263.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.72
|
| Rate for Payer: Meridian Medicaid |
$276.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$430.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$411.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,271.65
|
| Rate for Payer: Nomi Health Commercial |
$1,226.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.05
|
| Rate for Payer: PACE Senior Care Partners |
$355.31
|
| Rate for Payer: PACE SWMI |
$374.01
|
| Rate for Payer: PHP Commercial |
$1,271.65
|
| Rate for Payer: PHP Medicare Advantage |
$374.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,301.57
|
| Rate for Payer: Priority Health Medicare |
$377.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,041.26
|
| Rate for Payer: Railroad Medicare Medicare |
$374.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.53
|
| Rate for Payer: UHC Core |
$1,249.21
|
| Rate for Payer: UHC Exchange |
$374.01
|
| Rate for Payer: UHC Medicaid |
$263.76
|
| Rate for Payer: UHC Medicare Advantage |
$374.01
|
| Rate for Payer: UHCCP Medicaid |
$263.76
|
| Rate for Payer: VA VA |
$374.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,122.05
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$302.77 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna Medicare |
$87.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.13
|
| Rate for Payer: BCBS Complete |
$62.27
|
| Rate for Payer: BCBS MAPPO |
$84.10
|
| Rate for Payer: BCBS Trust/PPO |
$276.56
|
| Rate for Payer: BCN Commercial |
$276.56
|
| Rate for Payer: BCN Medicare Advantage |
$84.10
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.10
|
| Rate for Payer: Healthscope Commercial |
$302.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.31
|
| Rate for Payer: Mclaren Medicaid |
$59.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.31
|
| Rate for Payer: Meridian Medicaid |
$62.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Nomi Health Commercial |
$275.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: PACE Senior Care Partners |
$79.90
|
| Rate for Payer: PACE SWMI |
$84.10
|
| Rate for Payer: PHP Commercial |
$285.95
|
| Rate for Payer: PHP Medicare Advantage |
$84.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.68
|
| Rate for Payer: Priority Health Medicare |
$84.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.14
|
| Rate for Payer: Railroad Medicare Medicare |
$84.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.04
|
| Rate for Payer: UHC Core |
$280.90
|
| Rate for Payer: UHC Exchange |
$84.10
|
| Rate for Payer: UHC Medicaid |
$59.31
|
| Rate for Payer: UHC Medicare Advantage |
$84.10
|
| Rate for Payer: UHCCP Medicaid |
$59.31
|
| Rate for Payer: VA VA |
$84.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.31
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$336.41
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.14 |
| Max. Negotiated Rate |
$302.77 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: BCBS Trust/PPO |
$277.84
|
| Rate for Payer: BCN Commercial |
$277.84
|
| Rate for Payer: Cash Price |
$269.13
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.13
|
| Rate for Payer: Healthscope Commercial |
$302.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.95
|
| Rate for Payer: Nomi Health Commercial |
$275.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.31
|
| Rate for Payer: PHP Commercial |
$285.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.04
|
| Rate for Payer: UHC Core |
$280.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.31
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$121.64 |
| Rate for Payer: Aetna Commercial |
$114.88
|
| Rate for Payer: Aetna Medicare |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.23
|
| Rate for Payer: BCBS Complete |
$25.02
|
| Rate for Payer: BCBS MAPPO |
$33.79
|
| Rate for Payer: BCBS Trust/PPO |
$111.11
|
| Rate for Payer: BCN Commercial |
$111.11
|
| Rate for Payer: BCN Medicare Advantage |
$33.79
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Commercial |
$116.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.79
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.36
|
| Rate for Payer: Mclaren Medicaid |
$23.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.48
|
| Rate for Payer: Meridian Medicaid |
$25.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Nomi Health Commercial |
$110.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: PACE Senior Care Partners |
$32.10
|
| Rate for Payer: PACE SWMI |
$33.79
|
| Rate for Payer: PHP Commercial |
$114.88
|
| Rate for Payer: PHP Medicare Advantage |
$33.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.58
|
| Rate for Payer: Priority Health Medicare |
$34.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.06
|
| Rate for Payer: Railroad Medicare Medicare |
$33.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.93
|
| Rate for Payer: UHC Core |
$112.85
|
| Rate for Payer: UHC Exchange |
$33.79
|
| Rate for Payer: UHC Medicaid |
$23.83
|
| Rate for Payer: UHC Medicare Advantage |
$33.79
|
| Rate for Payer: UHCCP Medicaid |
$23.83
|
| Rate for Payer: VA VA |
$33.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.36
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$135.15
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$121.64 |
| Rate for Payer: Aetna Commercial |
$114.88
|
| Rate for Payer: BCBS Trust/PPO |
$111.62
|
| Rate for Payer: BCN Commercial |
$111.62
|
| Rate for Payer: Cash Price |
$108.12
|
| Rate for Payer: Cofinity Commercial |
$116.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.12
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.88
|
| Rate for Payer: Nomi Health Commercial |
$110.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.36
|
| Rate for Payer: PHP Commercial |
$114.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.93
|
| Rate for Payer: UHC Core |
$112.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.36
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,062.85 |
| Max. Negotiated Rate |
$1,374.37 |
| Rate for Payer: Aetna Commercial |
$1,298.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.22
|
| Rate for Payer: BCN Commercial |
$1,261.22
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Commercial |
$1,313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Healthscope Commercial |
$1,374.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,145.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Nomi Health Commercial |
$1,252.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: PHP Commercial |
$1,298.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,328.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,062.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,343.83
|
| Rate for Payer: UHC Core |
$1,275.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,145.31
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,527.08
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.22 |
| Max. Negotiated Rate |
$1,374.37 |
| Rate for Payer: Aetna Commercial |
$1,298.02
|
| Rate for Payer: Aetna Medicare |
$397.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$477.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$477.21
|
| Rate for Payer: BCBS Complete |
$282.66
|
| Rate for Payer: BCBS MAPPO |
$381.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.41
|
| Rate for Payer: BCN Commercial |
$1,255.41
|
| Rate for Payer: BCN Medicare Advantage |
$381.77
|
| Rate for Payer: Cash Price |
$1,221.66
|
| Rate for Payer: Cofinity Commercial |
$1,313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,221.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.77
|
| Rate for Payer: Healthscope Commercial |
$1,374.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,145.31
|
| Rate for Payer: Mclaren Medicaid |
$269.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.86
|
| Rate for Payer: Meridian Medicaid |
$282.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$419.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,298.02
|
| Rate for Payer: Nomi Health Commercial |
$1,252.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.31
|
| Rate for Payer: PACE Senior Care Partners |
$362.68
|
| Rate for Payer: PACE SWMI |
$381.77
|
| Rate for Payer: PHP Commercial |
$1,298.02
|
| Rate for Payer: PHP Medicare Advantage |
$381.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,328.56
|
| Rate for Payer: Priority Health Medicare |
$385.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,062.85
|
| Rate for Payer: Railroad Medicare Medicare |
$381.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,343.83
|
| Rate for Payer: UHC Core |
$1,275.11
|
| Rate for Payer: UHC Exchange |
$381.77
|
| Rate for Payer: UHC Medicaid |
$269.22
|
| Rate for Payer: UHC Medicare Advantage |
$381.77
|
| Rate for Payer: UHCCP Medicaid |
$269.22
|
| Rate for Payer: VA VA |
$381.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,145.31
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.67 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: BCBS Trust/PPO |
$124.21
|
| Rate for Payer: BCN Commercial |
$124.21
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$123.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.34
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.79
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$150.39
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.00
|
| Rate for Payer: BCBS Complete |
$27.84
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$123.64
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.79
|
| Rate for Payer: Mclaren Medicaid |
$26.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Meridian Medicaid |
$27.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$123.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.79
|
| Rate for Payer: PACE Senior Care Partners |
$35.72
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.84
|
| Rate for Payer: Priority Health Medicare |
$37.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.67
|
| Rate for Payer: Railroad Medicare Medicare |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.34
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: UHC Exchange |
$37.60
|
| Rate for Payer: UHC Medicaid |
$26.51
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: UHCCP Medicaid |
$26.51
|
| Rate for Payer: VA VA |
$37.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.79
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$313.78 |
| Rate for Payer: Aetna Commercial |
$296.34
|
| Rate for Payer: BCBS Trust/PPO |
$287.94
|
| Rate for Payer: BCN Commercial |
$287.94
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$299.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Healthscope Commercial |
$313.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Nomi Health Commercial |
$285.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: PHP Commercial |
$296.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$303.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.80
|
| Rate for Payer: UHC Core |
$291.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.48
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$348.64
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$313.78 |
| Rate for Payer: Aetna Commercial |
$296.34
|
| Rate for Payer: Aetna Medicare |
$90.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.95
|
| Rate for Payer: BCBS Complete |
$64.53
|
| Rate for Payer: BCBS MAPPO |
$87.16
|
| Rate for Payer: BCBS Trust/PPO |
$286.62
|
| Rate for Payer: BCN Commercial |
$286.62
|
| Rate for Payer: BCN Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$299.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.16
|
| Rate for Payer: Healthscope Commercial |
$313.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.48
|
| Rate for Payer: Mclaren Medicaid |
$61.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.52
|
| Rate for Payer: Meridian Medicaid |
$64.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.34
|
| Rate for Payer: Nomi Health Commercial |
$285.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.48
|
| Rate for Payer: PACE Senior Care Partners |
$82.80
|
| Rate for Payer: PACE SWMI |
$87.16
|
| Rate for Payer: PHP Commercial |
$296.34
|
| Rate for Payer: PHP Medicare Advantage |
$87.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$303.32
|
| Rate for Payer: Priority Health Medicare |
$88.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.65
|
| Rate for Payer: Railroad Medicare Medicare |
$87.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.80
|
| Rate for Payer: UHC Core |
$291.11
|
| Rate for Payer: UHC Exchange |
$87.16
|
| Rate for Payer: UHC Medicaid |
$61.47
|
| Rate for Payer: UHC Medicare Advantage |
$87.16
|
| Rate for Payer: UHCCP Medicaid |
$61.47
|
| Rate for Payer: VA VA |
$87.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.48
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$277.25 |
| Rate for Payer: Aetna Commercial |
$261.85
|
| Rate for Payer: Aetna Medicare |
$80.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.27
|
| Rate for Payer: BCBS Complete |
$57.02
|
| Rate for Payer: BCBS MAPPO |
$77.02
|
| Rate for Payer: BCBS Trust/PPO |
$253.26
|
| Rate for Payer: BCN Commercial |
$253.26
|
| Rate for Payer: BCN Medicare Advantage |
$77.02
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Commercial |
$264.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.02
|
| Rate for Payer: Healthscope Commercial |
$277.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.04
|
| Rate for Payer: Mclaren Medicaid |
$54.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.87
|
| Rate for Payer: Meridian Medicaid |
$57.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Nomi Health Commercial |
$252.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: PACE Senior Care Partners |
$73.16
|
| Rate for Payer: PACE SWMI |
$77.02
|
| Rate for Payer: PHP Commercial |
$261.85
|
| Rate for Payer: PHP Medicare Advantage |
$77.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.01
|
| Rate for Payer: Priority Health Medicare |
$77.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.41
|
| Rate for Payer: Railroad Medicare Medicare |
$77.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.09
|
| Rate for Payer: UHC Core |
$257.23
|
| Rate for Payer: UHC Exchange |
$77.02
|
| Rate for Payer: UHC Medicaid |
$54.31
|
| Rate for Payer: UHC Medicare Advantage |
$77.02
|
| Rate for Payer: UHCCP Medicaid |
$54.31
|
| Rate for Payer: VA VA |
$77.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.04
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$308.06
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$277.25 |
| Rate for Payer: Aetna Commercial |
$261.85
|
| Rate for Payer: BCBS Trust/PPO |
$254.43
|
| Rate for Payer: BCN Commercial |
$254.43
|
| Rate for Payer: Cash Price |
$246.45
|
| Rate for Payer: Cofinity Commercial |
$264.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.45
|
| Rate for Payer: Healthscope Commercial |
$277.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.85
|
| Rate for Payer: Nomi Health Commercial |
$252.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.04
|
| Rate for Payer: PHP Commercial |
$261.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.09
|
| Rate for Payer: UHC Core |
$257.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.04
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$88.17 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$25.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.62
|
| Rate for Payer: BCBS Complete |
$18.13
|
| Rate for Payer: BCBS MAPPO |
$24.49
|
| Rate for Payer: BCBS Trust/PPO |
$80.54
|
| Rate for Payer: BCN Commercial |
$80.54
|
| Rate for Payer: BCN Medicare Advantage |
$24.49
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$88.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.48
|
| Rate for Payer: Mclaren Medicaid |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.72
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Nomi Health Commercial |
$80.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: PACE Senior Care Partners |
$23.27
|
| Rate for Payer: PACE SWMI |
$24.49
|
| Rate for Payer: PHP Commercial |
$83.27
|
| Rate for Payer: PHP Medicare Advantage |
$24.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.23
|
| Rate for Payer: Priority Health Medicare |
$24.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.21
|
| Rate for Payer: UHC Core |
$81.80
|
| Rate for Payer: UHC Exchange |
$24.49
|
| Rate for Payer: UHC Medicaid |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$24.49
|
| Rate for Payer: UHCCP Medicaid |
$17.27
|
| Rate for Payer: VA VA |
$24.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.48
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$97.97
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$88.17 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: BCBS Trust/PPO |
$80.91
|
| Rate for Payer: BCN Commercial |
$80.91
|
| Rate for Payer: Cash Price |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.38
|
| Rate for Payer: Healthscope Commercial |
$88.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.27
|
| Rate for Payer: Nomi Health Commercial |
$80.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.48
|
| Rate for Payer: PHP Commercial |
$83.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.21
|
| Rate for Payer: UHC Core |
$81.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.48
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$1,029.33 |
| Rate for Payer: Aetna Commercial |
$972.14
|
| Rate for Payer: Aetna Medicare |
$297.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.41
|
| Rate for Payer: BCBS Complete |
$211.70
|
| Rate for Payer: BCBS MAPPO |
$285.93
|
| Rate for Payer: BCBS Trust/PPO |
$940.24
|
| Rate for Payer: BCN Commercial |
$940.24
|
| Rate for Payer: BCN Medicare Advantage |
$285.93
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Commercial |
$983.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.93
|
| Rate for Payer: Healthscope Commercial |
$1,029.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.77
|
| Rate for Payer: Mclaren Medicaid |
$201.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.22
|
| Rate for Payer: Meridian Medicaid |
$211.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$314.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Nomi Health Commercial |
$937.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: PACE Senior Care Partners |
$271.63
|
| Rate for Payer: PACE SWMI |
$285.93
|
| Rate for Payer: PHP Commercial |
$972.14
|
| Rate for Payer: PHP Medicare Advantage |
$285.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$995.02
|
| Rate for Payer: Priority Health Medicare |
$288.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$796.02
|
| Rate for Payer: Railroad Medicare Medicare |
$285.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.46
|
| Rate for Payer: UHC Core |
$954.99
|
| Rate for Payer: UHC Exchange |
$285.93
|
| Rate for Payer: UHC Medicaid |
$201.63
|
| Rate for Payer: UHC Medicare Advantage |
$285.93
|
| Rate for Payer: UHCCP Medicaid |
$201.63
|
| Rate for Payer: VA VA |
$285.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.77
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$796.02 |
| Max. Negotiated Rate |
$1,029.33 |
| Rate for Payer: Aetna Commercial |
$972.14
|
| Rate for Payer: BCBS Trust/PPO |
$944.58
|
| Rate for Payer: BCN Commercial |
$944.58
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Commercial |
$983.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,029.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Nomi Health Commercial |
$937.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: PHP Commercial |
$972.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$995.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$796.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.46
|
| Rate for Payer: UHC Core |
$954.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.77
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$893.80 |
| Max. Negotiated Rate |
$1,155.78 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,060.62
|
| Rate for Payer: BCN Commercial |
$1,060.62
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Nomi Health Commercial |
$1,053.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,117.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$893.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.10
|
| Rate for Payer: UHC Core |
$1,072.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.15
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.40 |
| Max. Negotiated Rate |
$1,155.78 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna Medicare |
$333.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$401.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$401.31
|
| Rate for Payer: BCBS Complete |
$237.71
|
| Rate for Payer: BCBS MAPPO |
$321.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.74
|
| Rate for Payer: BCN Commercial |
$1,055.74
|
| Rate for Payer: BCN Medicare Advantage |
$321.05
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.05
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.15
|
| Rate for Payer: Mclaren Medicaid |
$226.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.10
|
| Rate for Payer: Meridian Medicaid |
$237.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$369.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$353.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Nomi Health Commercial |
$1,053.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PACE Senior Care Partners |
$305.00
|
| Rate for Payer: PACE SWMI |
$321.05
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: PHP Medicare Advantage |
$321.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,117.25
|
| Rate for Payer: Priority Health Medicare |
$324.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$893.80
|
| Rate for Payer: Railroad Medicare Medicare |
$321.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.10
|
| Rate for Payer: UHC Core |
$1,072.31
|
| Rate for Payer: UHC Exchange |
$321.05
|
| Rate for Payer: UHC Medicaid |
$226.40
|
| Rate for Payer: UHC Medicare Advantage |
$321.05
|
| Rate for Payer: UHCCP Medicaid |
$226.40
|
| Rate for Payer: VA VA |
$321.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.15
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$192.59 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$284.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.38
|
| Rate for Payer: BCBS Complete |
$202.21
|
| Rate for Payer: BCBS MAPPO |
$273.11
|
| Rate for Payer: BCBS Trust/PPO |
$898.08
|
| Rate for Payer: BCN Commercial |
$898.08
|
| Rate for Payer: BCN Medicare Advantage |
$273.11
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.11
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Mclaren Medicaid |
$192.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.76
|
| Rate for Payer: Meridian Medicaid |
$202.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$300.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PACE Senior Care Partners |
$259.45
|
| Rate for Payer: PACE SWMI |
$273.11
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$273.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Medicare |
$275.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.32
|
| Rate for Payer: Railroad Medicare Medicare |
$273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: UHC Exchange |
$273.11
|
| Rate for Payer: UHC Medicaid |
$192.59
|
| Rate for Payer: UHC Medicare Advantage |
$273.11
|
| Rate for Payer: UHCCP Medicaid |
$192.59
|
| Rate for Payer: VA VA |
$273.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$760.32 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: BCBS Trust/PPO |
$902.23
|
| Rate for Payer: BCN Commercial |
$902.23
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,057.87 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: Aetna Medicare |
$1,560.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,875.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,875.12
|
| Rate for Payer: BCBS Complete |
$1,110.67
|
| Rate for Payer: BCBS MAPPO |
$1,500.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,932.91
|
| Rate for Payer: BCN Commercial |
$4,932.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,500.10
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,500.10
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,500.28
|
| Rate for Payer: Mclaren Medicaid |
$1,057.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,575.10
|
| Rate for Payer: Meridian Medicaid |
$1,110.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,725.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,650.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Nomi Health Commercial |
$4,920.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PACE Senior Care Partners |
$1,425.09
|
| Rate for Payer: PACE SWMI |
$1,500.10
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,500.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,057.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,220.33
|
| Rate for Payer: Priority Health Medicare |
$1,515.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,176.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,500.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,280.33
|
| Rate for Payer: UHC Core |
$5,010.32
|
| Rate for Payer: UHC Exchange |
$1,500.10
|
| Rate for Payer: UHC Medicaid |
$1,057.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,500.10
|
| Rate for Payer: UHCCP Medicaid |
$1,057.87
|
| Rate for Payer: VA VA |
$1,500.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,500.28
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,176.26 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,955.71
|
| Rate for Payer: BCN Commercial |
$4,955.71
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,500.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Nomi Health Commercial |
$4,920.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,220.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,176.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,280.33
|
| Rate for Payer: UHC Core |
$5,010.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,500.28
|
|
