|
HC BRACE CTO
|
Facility
|
OP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.51 |
| Max. Negotiated Rate |
$1,360.53 |
| Rate for Payer: Aetna Commercial |
$1,284.94
|
| Rate for Payer: Aetna Medicare |
$393.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$472.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$472.41
|
| Rate for Payer: BCBS Complete |
$279.82
|
| Rate for Payer: BCBS MAPPO |
$377.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.77
|
| Rate for Payer: BCN Commercial |
$1,242.77
|
| Rate for Payer: BCN Medicare Advantage |
$377.93
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Commercial |
$1,300.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.93
|
| Rate for Payer: Healthscope Commercial |
$1,360.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.78
|
| Rate for Payer: Mclaren Medicaid |
$266.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$396.82
|
| Rate for Payer: Meridian Medicaid |
$279.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$415.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Nomi Health Commercial |
$1,239.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: PACE Senior Care Partners |
$359.03
|
| Rate for Payer: PACE SWMI |
$377.93
|
| Rate for Payer: PHP Commercial |
$1,284.94
|
| Rate for Payer: PHP Medicare Advantage |
$377.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,315.18
|
| Rate for Payer: Priority Health Medicare |
$381.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,052.14
|
| Rate for Payer: Railroad Medicare Medicare |
$377.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,330.30
|
| Rate for Payer: UHC Core |
$1,262.27
|
| Rate for Payer: UHC Exchange |
$377.93
|
| Rate for Payer: UHC Medicaid |
$266.51
|
| Rate for Payer: UHC Medicare Advantage |
$377.93
|
| Rate for Payer: UHCCP Medicaid |
$266.51
|
| Rate for Payer: VA VA |
$377.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.78
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,052.14 |
| Max. Negotiated Rate |
$1,360.53 |
| Rate for Payer: Aetna Commercial |
$1,284.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.51
|
| Rate for Payer: BCN Commercial |
$1,248.51
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Commercial |
$1,300.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,360.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Nomi Health Commercial |
$1,239.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: PHP Commercial |
$1,284.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,315.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,052.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,330.30
|
| Rate for Payer: UHC Core |
$1,262.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.78
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: Aetna Medicare |
$73.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.78
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$70.23
|
| Rate for Payer: BCBS Trust/PPO |
$230.94
|
| Rate for Payer: BCN Commercial |
$230.94
|
| Rate for Payer: BCN Medicare Advantage |
$70.23
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Commercial |
$241.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.23
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.68
|
| Rate for Payer: Mclaren Medicaid |
$49.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.74
|
| Rate for Payer: Meridian Medicaid |
$52.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Nomi Health Commercial |
$230.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: PACE Senior Care Partners |
$66.72
|
| Rate for Payer: PACE SWMI |
$70.23
|
| Rate for Payer: PHP Commercial |
$238.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.39
|
| Rate for Payer: Priority Health Medicare |
$70.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.51
|
| Rate for Payer: Railroad Medicare Medicare |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.20
|
| Rate for Payer: UHC Core |
$234.56
|
| Rate for Payer: UHC Exchange |
$70.23
|
| Rate for Payer: UHC Medicaid |
$49.52
|
| Rate for Payer: UHC Medicare Advantage |
$70.23
|
| Rate for Payer: UHCCP Medicaid |
$49.52
|
| Rate for Payer: VA VA |
$70.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.68
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: BCBS Trust/PPO |
$232.00
|
| Rate for Payer: BCN Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Commercial |
$241.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Nomi Health Commercial |
$230.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: PHP Commercial |
$238.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.20
|
| Rate for Payer: UHC Core |
$234.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.68
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: Aetna Medicare |
$18.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.43
|
| Rate for Payer: BCBS Complete |
$13.29
|
| Rate for Payer: BCBS MAPPO |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$59.02
|
| Rate for Payer: BCN Commercial |
$59.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.95
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$12.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.84
|
| Rate for Payer: Meridian Medicaid |
$13.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PACE Senior Care Partners |
$17.05
|
| Rate for Payer: PACE SWMI |
$17.95
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: PHP Medicare Advantage |
$17.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.46
|
| Rate for Payer: Priority Health Medicare |
$18.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.18
|
| Rate for Payer: UHC Core |
$59.94
|
| Rate for Payer: UHC Exchange |
$17.95
|
| Rate for Payer: UHC Medicaid |
$12.66
|
| Rate for Payer: UHC Medicare Advantage |
$17.95
|
| Rate for Payer: UHCCP Medicaid |
$12.66
|
| Rate for Payer: VA VA |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.97 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.29
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.18
|
| Rate for Payer: UHC Core |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$764.55 |
| Max. Negotiated Rate |
$988.64 |
| Rate for Payer: Aetna Commercial |
$933.72
|
| Rate for Payer: BCBS Trust/PPO |
$907.24
|
| Rate for Payer: BCN Commercial |
$907.24
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Commercial |
$944.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Healthscope Commercial |
$988.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Nomi Health Commercial |
$900.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: PHP Commercial |
$933.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$955.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$764.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.67
|
| Rate for Payer: UHC Core |
$917.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.87
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.66 |
| Max. Negotiated Rate |
$988.64 |
| Rate for Payer: Aetna Commercial |
$933.72
|
| Rate for Payer: Aetna Medicare |
$285.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.28
|
| Rate for Payer: BCBS Complete |
$203.33
|
| Rate for Payer: BCBS MAPPO |
$274.62
|
| Rate for Payer: BCBS Trust/PPO |
$903.07
|
| Rate for Payer: BCN Commercial |
$903.07
|
| Rate for Payer: BCN Medicare Advantage |
$274.62
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Commercial |
$944.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.62
|
| Rate for Payer: Healthscope Commercial |
$988.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.87
|
| Rate for Payer: Mclaren Medicaid |
$193.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.35
|
| Rate for Payer: Meridian Medicaid |
$203.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Nomi Health Commercial |
$900.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: PACE Senior Care Partners |
$260.89
|
| Rate for Payer: PACE SWMI |
$274.62
|
| Rate for Payer: PHP Commercial |
$933.72
|
| Rate for Payer: PHP Medicare Advantage |
$274.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$955.69
|
| Rate for Payer: Priority Health Medicare |
$277.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$764.55
|
| Rate for Payer: Railroad Medicare Medicare |
$274.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.67
|
| Rate for Payer: UHC Core |
$917.24
|
| Rate for Payer: UHC Exchange |
$274.62
|
| Rate for Payer: UHC Medicaid |
$193.66
|
| Rate for Payer: UHC Medicare Advantage |
$274.62
|
| Rate for Payer: UHCCP Medicaid |
$193.66
|
| Rate for Payer: VA VA |
$274.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.87
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$496.02 |
| Max. Negotiated Rate |
$641.40 |
| Rate for Payer: Aetna Commercial |
$605.77
|
| Rate for Payer: BCBS Trust/PPO |
$588.59
|
| Rate for Payer: BCN Commercial |
$588.59
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Commercial |
$612.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Nomi Health Commercial |
$584.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: PHP Commercial |
$605.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$620.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$496.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.15
|
| Rate for Payer: UHC Core |
$595.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.50
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.64 |
| Max. Negotiated Rate |
$641.40 |
| Rate for Payer: Aetna Commercial |
$605.77
|
| Rate for Payer: Aetna Medicare |
$185.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.71
|
| Rate for Payer: BCBS Complete |
$131.92
|
| Rate for Payer: BCBS MAPPO |
$178.17
|
| Rate for Payer: BCBS Trust/PPO |
$585.89
|
| Rate for Payer: BCN Commercial |
$585.89
|
| Rate for Payer: BCN Medicare Advantage |
$178.17
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Commercial |
$612.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.17
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.50
|
| Rate for Payer: Mclaren Medicaid |
$125.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.08
|
| Rate for Payer: Meridian Medicaid |
$131.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Nomi Health Commercial |
$584.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: PACE Senior Care Partners |
$169.26
|
| Rate for Payer: PACE SWMI |
$178.17
|
| Rate for Payer: PHP Commercial |
$605.77
|
| Rate for Payer: PHP Medicare Advantage |
$178.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$620.02
|
| Rate for Payer: Priority Health Medicare |
$179.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$496.02
|
| Rate for Payer: Railroad Medicare Medicare |
$178.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.15
|
| Rate for Payer: UHC Core |
$595.08
|
| Rate for Payer: UHC Exchange |
$178.17
|
| Rate for Payer: UHC Medicaid |
$125.64
|
| Rate for Payer: UHC Medicare Advantage |
$178.17
|
| Rate for Payer: UHCCP Medicaid |
$125.64
|
| Rate for Payer: VA VA |
$178.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.50
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$34.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$7.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicaid |
$7.34
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$34.37
|
| Rate for Payer: BCN Commercial |
$34.37
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Aetna Commercial |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$168.42
|
| Rate for Payer: BCN Commercial |
$168.42
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Healthscope Commercial |
$183.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$167.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: PHP Commercial |
$173.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.45
|
| Rate for Payer: UHC Core |
$170.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.94
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Aetna Commercial |
$173.33
|
| Rate for Payer: Aetna Medicare |
$53.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.73
|
| Rate for Payer: BCBS Complete |
$37.75
|
| Rate for Payer: BCBS MAPPO |
$50.98
|
| Rate for Payer: BCBS Trust/PPO |
$167.64
|
| Rate for Payer: BCN Commercial |
$167.64
|
| Rate for Payer: BCN Medicare Advantage |
$50.98
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.98
|
| Rate for Payer: Healthscope Commercial |
$183.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.94
|
| Rate for Payer: Mclaren Medicaid |
$35.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.53
|
| Rate for Payer: Meridian Medicaid |
$37.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Nomi Health Commercial |
$167.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: PACE Senior Care Partners |
$48.43
|
| Rate for Payer: PACE SWMI |
$50.98
|
| Rate for Payer: PHP Commercial |
$173.33
|
| Rate for Payer: PHP Medicare Advantage |
$50.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.41
|
| Rate for Payer: Priority Health Medicare |
$51.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.93
|
| Rate for Payer: Railroad Medicare Medicare |
$50.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.45
|
| Rate for Payer: UHC Core |
$170.27
|
| Rate for Payer: UHC Exchange |
$50.98
|
| Rate for Payer: UHC Medicaid |
$35.95
|
| Rate for Payer: UHC Medicare Advantage |
$50.98
|
| Rate for Payer: UHCCP Medicaid |
$35.95
|
| Rate for Payer: VA VA |
$50.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.94
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$431.11
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$366.44
|
| Rate for Payer: Aetna Medicare |
$112.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.72
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: BCBS MAPPO |
$107.78
|
| Rate for Payer: BCBS Trust/PPO |
$354.42
|
| Rate for Payer: BCN Commercial |
$354.42
|
| Rate for Payer: BCN Medicare Advantage |
$107.78
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cofinity Commercial |
$370.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.78
|
| Rate for Payer: Healthscope Commercial |
$388.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.33
|
| Rate for Payer: Mclaren Medicaid |
$76.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.17
|
| Rate for Payer: Meridian Medicaid |
$79.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.44
|
| Rate for Payer: Nomi Health Commercial |
$353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.33
|
| Rate for Payer: PACE Senior Care Partners |
$102.39
|
| Rate for Payer: PACE SWMI |
$107.78
|
| Rate for Payer: PHP Commercial |
$366.44
|
| Rate for Payer: PHP Medicare Advantage |
$107.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.07
|
| Rate for Payer: Priority Health Medicare |
$108.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.05
|
| Rate for Payer: Railroad Medicare Medicare |
$107.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.38
|
| Rate for Payer: UHC Core |
$359.98
|
| Rate for Payer: UHC Exchange |
$107.78
|
| Rate for Payer: UHC Medicaid |
$76.00
|
| Rate for Payer: UHC Medicare Advantage |
$107.78
|
| Rate for Payer: UHCCP Medicaid |
$76.00
|
| Rate for Payer: VA VA |
$107.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.33
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$431.11
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.05 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$366.44
|
| Rate for Payer: BCBS Trust/PPO |
$356.05
|
| Rate for Payer: BCN Commercial |
$356.05
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cofinity Commercial |
$370.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.89
|
| Rate for Payer: Healthscope Commercial |
$388.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.44
|
| Rate for Payer: Nomi Health Commercial |
$353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.33
|
| Rate for Payer: PHP Commercial |
$366.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.38
|
| Rate for Payer: UHC Core |
$359.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.33
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$465.59 |
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.66
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: BCBS MAPPO |
$129.33
|
| Rate for Payer: BCBS Trust/PPO |
$425.29
|
| Rate for Payer: BCN Commercial |
$425.29
|
| Rate for Payer: BCN Medicare Advantage |
$129.33
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Commercial |
$444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.33
|
| Rate for Payer: Healthscope Commercial |
$465.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.99
|
| Rate for Payer: Mclaren Medicaid |
$91.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.80
|
| Rate for Payer: Meridian Medicaid |
$95.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Nomi Health Commercial |
$424.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: PACE Senior Care Partners |
$122.86
|
| Rate for Payer: PACE SWMI |
$129.33
|
| Rate for Payer: PHP Commercial |
$439.72
|
| Rate for Payer: PHP Medicare Advantage |
$129.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.07
|
| Rate for Payer: Priority Health Medicare |
$130.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.05
|
| Rate for Payer: Railroad Medicare Medicare |
$129.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.24
|
| Rate for Payer: UHC Core |
$431.96
|
| Rate for Payer: UHC Exchange |
$129.33
|
| Rate for Payer: UHC Medicaid |
$91.20
|
| Rate for Payer: UHC Medicare Advantage |
$129.33
|
| Rate for Payer: UHCCP Medicaid |
$91.20
|
| Rate for Payer: VA VA |
$129.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.99
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.05 |
| Max. Negotiated Rate |
$465.59 |
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: BCBS Trust/PPO |
$427.25
|
| Rate for Payer: BCN Commercial |
$427.25
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Commercial |
$444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Healthscope Commercial |
$465.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Nomi Health Commercial |
$424.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: PHP Commercial |
$439.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.24
|
| Rate for Payer: UHC Core |
$431.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.99
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: Aetna Medicare |
$79.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.59
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: BCBS MAPPO |
$76.47
|
| Rate for Payer: BCBS Trust/PPO |
$251.46
|
| Rate for Payer: BCN Commercial |
$251.46
|
| Rate for Payer: BCN Medicare Advantage |
$76.47
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.47
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.41
|
| Rate for Payer: Mclaren Medicaid |
$53.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.29
|
| Rate for Payer: Meridian Medicaid |
$56.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Nomi Health Commercial |
$250.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: PACE Senior Care Partners |
$72.65
|
| Rate for Payer: PACE SWMI |
$76.47
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: PHP Medicare Advantage |
$76.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.12
|
| Rate for Payer: Priority Health Medicare |
$77.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.89
|
| Rate for Payer: Railroad Medicare Medicare |
$76.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.17
|
| Rate for Payer: UHC Core |
$255.41
|
| Rate for Payer: UHC Exchange |
$76.47
|
| Rate for Payer: UHC Medicaid |
$53.93
|
| Rate for Payer: UHC Medicare Advantage |
$76.47
|
| Rate for Payer: UHCCP Medicaid |
$53.93
|
| Rate for Payer: VA VA |
$76.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.41
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$212.89 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: BCBS Trust/PPO |
$252.63
|
| Rate for Payer: BCN Commercial |
$252.63
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Nomi Health Commercial |
$250.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$266.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.17
|
| Rate for Payer: UHC Core |
$255.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.41
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$471.82 |
| Rate for Payer: Aetna Commercial |
$445.60
|
| Rate for Payer: BCBS Trust/PPO |
$432.97
|
| Rate for Payer: BCN Commercial |
$432.97
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Commercial |
$450.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Healthscope Commercial |
$471.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Nomi Health Commercial |
$429.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: PHP Commercial |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$456.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$364.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.33
|
| Rate for Payer: UHC Core |
$437.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.18
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$471.82 |
| Rate for Payer: Aetna Commercial |
$445.60
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.82
|
| Rate for Payer: BCBS Complete |
$97.04
|
| Rate for Payer: BCBS MAPPO |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$430.98
|
| Rate for Payer: BCN Commercial |
$430.98
|
| Rate for Payer: BCN Medicare Advantage |
$131.06
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Commercial |
$450.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.06
|
| Rate for Payer: Healthscope Commercial |
$471.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.18
|
| Rate for Payer: Mclaren Medicaid |
$92.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.61
|
| Rate for Payer: Meridian Medicaid |
$97.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$144.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Nomi Health Commercial |
$429.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: PACE Senior Care Partners |
$124.51
|
| Rate for Payer: PACE SWMI |
$131.06
|
| Rate for Payer: PHP Commercial |
$445.60
|
| Rate for Payer: PHP Medicare Advantage |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$456.09
|
| Rate for Payer: Priority Health Medicare |
$132.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$364.87
|
| Rate for Payer: Railroad Medicare Medicare |
$131.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.33
|
| Rate for Payer: UHC Core |
$437.74
|
| Rate for Payer: UHC Exchange |
$131.06
|
| Rate for Payer: UHC Medicaid |
$92.42
|
| Rate for Payer: UHC Medicare Advantage |
$131.06
|
| Rate for Payer: UHCCP Medicaid |
$92.42
|
| Rate for Payer: VA VA |
$131.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.18
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.67 |
| Max. Negotiated Rate |
$386.29 |
| Rate for Payer: Aetna Commercial |
$364.83
|
| Rate for Payer: Aetna Medicare |
$111.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.13
|
| Rate for Payer: BCBS Complete |
$79.45
|
| Rate for Payer: BCBS MAPPO |
$107.30
|
| Rate for Payer: BCBS Trust/PPO |
$352.85
|
| Rate for Payer: BCN Commercial |
$352.85
|
| Rate for Payer: BCN Medicare Advantage |
$107.30
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.30
|
| Rate for Payer: Healthscope Commercial |
$386.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.91
|
| Rate for Payer: Mclaren Medicaid |
$75.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.67
|
| Rate for Payer: Meridian Medicaid |
$79.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Nomi Health Commercial |
$351.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: PACE Senior Care Partners |
$101.94
|
| Rate for Payer: PACE SWMI |
$107.30
|
| Rate for Payer: PHP Commercial |
$364.83
|
| Rate for Payer: PHP Medicare Advantage |
$107.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.41
|
| Rate for Payer: Priority Health Medicare |
$108.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.73
|
| Rate for Payer: Railroad Medicare Medicare |
$107.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.70
|
| Rate for Payer: UHC Core |
$358.39
|
| Rate for Payer: UHC Exchange |
$107.30
|
| Rate for Payer: UHC Medicaid |
$75.67
|
| Rate for Payer: UHC Medicare Advantage |
$107.30
|
| Rate for Payer: UHCCP Medicaid |
$75.67
|
| Rate for Payer: VA VA |
$107.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.91
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$386.29 |
| Rate for Payer: Aetna Commercial |
$364.83
|
| Rate for Payer: BCBS Trust/PPO |
$354.48
|
| Rate for Payer: BCN Commercial |
$354.48
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Healthscope Commercial |
$386.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Nomi Health Commercial |
$351.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: PHP Commercial |
$364.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.70
|
| Rate for Payer: UHC Core |
$358.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.91
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: BCBS Trust/PPO |
$154.67
|
| Rate for Payer: BCN Commercial |
$154.67
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.80
|
| Rate for Payer: UHC Core |
$156.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.45
|
|
