|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,605.60
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,813.50 |
| Max. Negotiated Rate |
$2,345.04 |
| Rate for Payer: Aetna Commercial |
$2,214.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,151.97
|
| Rate for Payer: BCN Commercial |
$2,151.97
|
| Rate for Payer: Cash Price |
$2,084.48
|
| Rate for Payer: Cofinity Commercial |
$2,240.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,084.48
|
| Rate for Payer: Healthscope Commercial |
$2,345.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,214.76
|
| Rate for Payer: Nomi Health Commercial |
$2,136.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.20
|
| Rate for Payer: PHP Commercial |
$2,214.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,266.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,813.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,292.93
|
| Rate for Payer: UHC Core |
$2,175.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.20
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,605.60
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.37 |
| Max. Negotiated Rate |
$2,345.04 |
| Rate for Payer: Aetna Commercial |
$2,214.76
|
| Rate for Payer: Aetna Medicare |
$677.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$814.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$814.25
|
| Rate for Payer: BCBS Complete |
$482.30
|
| Rate for Payer: BCBS MAPPO |
$651.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,142.06
|
| Rate for Payer: BCN Commercial |
$2,142.06
|
| Rate for Payer: BCN Medicare Advantage |
$651.40
|
| Rate for Payer: Cash Price |
$2,084.48
|
| Rate for Payer: Cofinity Commercial |
$2,240.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,084.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$651.40
|
| Rate for Payer: Healthscope Commercial |
$2,345.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.20
|
| Rate for Payer: Mclaren Medicaid |
$459.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.97
|
| Rate for Payer: Meridian Medicaid |
$482.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$749.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$716.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,214.76
|
| Rate for Payer: Nomi Health Commercial |
$2,136.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.20
|
| Rate for Payer: PACE Senior Care Partners |
$618.83
|
| Rate for Payer: PACE SWMI |
$651.40
|
| Rate for Payer: PHP Commercial |
$2,214.76
|
| Rate for Payer: PHP Medicare Advantage |
$651.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,266.87
|
| Rate for Payer: Priority Health Medicare |
$657.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,813.50
|
| Rate for Payer: Railroad Medicare Medicare |
$651.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,292.93
|
| Rate for Payer: UHC Core |
$2,175.68
|
| Rate for Payer: UHC Exchange |
$651.40
|
| Rate for Payer: UHC Medicaid |
$459.37
|
| Rate for Payer: UHC Medicare Advantage |
$651.40
|
| Rate for Payer: UHCCP Medicaid |
$459.37
|
| Rate for Payer: VA VA |
$651.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.20
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,496.30 |
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: Aetna Medicare |
$721.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$866.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$866.77
|
| Rate for Payer: BCBS Complete |
$513.41
|
| Rate for Payer: BCBS MAPPO |
$693.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,280.23
|
| Rate for Payer: BCN Commercial |
$2,280.23
|
| Rate for Payer: BCN Medicare Advantage |
$693.42
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.42
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,080.25
|
| Rate for Payer: Mclaren Medicaid |
$489.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.09
|
| Rate for Payer: Meridian Medicaid |
$513.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$797.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$762.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Nomi Health Commercial |
$2,274.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PACE Senior Care Partners |
$658.75
|
| Rate for Payer: PACE SWMI |
$693.42
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: PHP Medicare Advantage |
$693.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,413.09
|
| Rate for Payer: Priority Health Medicare |
$700.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,930.47
|
| Rate for Payer: Railroad Medicare Medicare |
$693.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,440.83
|
| Rate for Payer: UHC Core |
$2,316.01
|
| Rate for Payer: UHC Exchange |
$693.42
|
| Rate for Payer: UHC Medicaid |
$489.00
|
| Rate for Payer: UHC Medicare Advantage |
$693.42
|
| Rate for Payer: UHCCP Medicaid |
$489.00
|
| Rate for Payer: VA VA |
$693.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,080.25
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,930.47 |
| Max. Negotiated Rate |
$2,496.30 |
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,290.77
|
| Rate for Payer: BCN Commercial |
$2,290.77
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,080.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Nomi Health Commercial |
$2,274.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,413.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,930.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,440.83
|
| Rate for Payer: UHC Core |
$2,316.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,080.25
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna Medicare |
$98.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.52
|
| Rate for Payer: BCBS Complete |
$70.20
|
| Rate for Payer: BCBS MAPPO |
$94.81
|
| Rate for Payer: BCBS Trust/PPO |
$311.78
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$94.81
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.81
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.44
|
| Rate for Payer: Mclaren Medicaid |
$66.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.55
|
| Rate for Payer: Meridian Medicaid |
$70.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Nomi Health Commercial |
$310.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PACE Senior Care Partners |
$90.07
|
| Rate for Payer: PACE SWMI |
$94.81
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: PHP Medicare Advantage |
$94.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$329.95
|
| Rate for Payer: Priority Health Medicare |
$95.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.96
|
| Rate for Payer: Railroad Medicare Medicare |
$94.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.74
|
| Rate for Payer: UHC Core |
$316.67
|
| Rate for Payer: UHC Exchange |
$94.81
|
| Rate for Payer: UHC Medicaid |
$66.86
|
| Rate for Payer: UHC Medicare Advantage |
$94.81
|
| Rate for Payer: UHCCP Medicaid |
$66.86
|
| Rate for Payer: VA VA |
$94.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.44
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: BCBS Trust/PPO |
$313.22
|
| Rate for Payer: BCN Commercial |
$313.22
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Nomi Health Commercial |
$310.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$329.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.74
|
| Rate for Payer: UHC Core |
$316.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.44
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna Medicare |
$105.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.57
|
| Rate for Payer: BCBS Complete |
$74.97
|
| Rate for Payer: BCBS MAPPO |
$101.26
|
| Rate for Payer: BCBS Trust/PPO |
$332.98
|
| Rate for Payer: BCN Commercial |
$332.98
|
| Rate for Payer: BCN Medicare Advantage |
$101.26
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.26
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.77
|
| Rate for Payer: Mclaren Medicaid |
$71.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.32
|
| Rate for Payer: Meridian Medicaid |
$74.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Nomi Health Commercial |
$332.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PACE Senior Care Partners |
$96.19
|
| Rate for Payer: PACE SWMI |
$101.26
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: PHP Medicare Advantage |
$101.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.38
|
| Rate for Payer: Priority Health Medicare |
$102.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.90
|
| Rate for Payer: Railroad Medicare Medicare |
$101.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.43
|
| Rate for Payer: UHC Core |
$338.20
|
| Rate for Payer: UHC Exchange |
$101.26
|
| Rate for Payer: UHC Medicaid |
$71.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.26
|
| Rate for Payer: UHCCP Medicaid |
$71.41
|
| Rate for Payer: VA VA |
$101.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.77
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.90 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: BCBS Trust/PPO |
$334.51
|
| Rate for Payer: BCN Commercial |
$334.51
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Nomi Health Commercial |
$332.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.43
|
| Rate for Payer: UHC Core |
$338.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.77
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.55 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: Aetna Medicare |
$115.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.23
|
| Rate for Payer: BCBS Complete |
$82.47
|
| Rate for Payer: BCBS MAPPO |
$111.38
|
| Rate for Payer: BCBS Trust/PPO |
$366.27
|
| Rate for Payer: BCN Commercial |
$366.27
|
| Rate for Payer: BCN Medicare Advantage |
$111.38
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.38
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.15
|
| Rate for Payer: Mclaren Medicaid |
$78.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.95
|
| Rate for Payer: Meridian Medicaid |
$82.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Nomi Health Commercial |
$365.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PACE Senior Care Partners |
$105.81
|
| Rate for Payer: PACE SWMI |
$111.38
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: PHP Medicare Advantage |
$111.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$387.61
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.09
|
| Rate for Payer: Railroad Medicare Medicare |
$111.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.07
|
| Rate for Payer: UHC Core |
$372.02
|
| Rate for Payer: UHC Exchange |
$111.38
|
| Rate for Payer: UHC Medicaid |
$78.55
|
| Rate for Payer: UHC Medicare Advantage |
$111.38
|
| Rate for Payer: UHCCP Medicaid |
$78.55
|
| Rate for Payer: VA VA |
$111.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.15
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.09 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: BCBS Trust/PPO |
$367.96
|
| Rate for Payer: BCN Commercial |
$367.96
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Nomi Health Commercial |
$365.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$387.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.07
|
| Rate for Payer: UHC Core |
$372.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.15
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna Medicare |
$142.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.63
|
| Rate for Payer: BCBS Complete |
$101.66
|
| Rate for Payer: BCBS MAPPO |
$137.31
|
| Rate for Payer: BCBS Trust/PPO |
$451.51
|
| Rate for Payer: BCN Commercial |
$451.51
|
| Rate for Payer: BCN Medicare Advantage |
$137.31
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.31
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: Mclaren Medicaid |
$96.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.17
|
| Rate for Payer: Meridian Medicaid |
$101.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Nomi Health Commercial |
$450.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PACE Senior Care Partners |
$130.44
|
| Rate for Payer: PACE SWMI |
$137.31
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: PHP Medicare Advantage |
$137.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$477.82
|
| Rate for Payer: Priority Health Medicare |
$138.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.26
|
| Rate for Payer: Railroad Medicare Medicare |
$137.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.31
|
| Rate for Payer: UHC Core |
$458.60
|
| Rate for Payer: UHC Exchange |
$137.31
|
| Rate for Payer: UHC Medicaid |
$96.83
|
| Rate for Payer: UHC Medicare Advantage |
$137.31
|
| Rate for Payer: UHCCP Medicaid |
$96.83
|
| Rate for Payer: VA VA |
$137.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$382.26 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: BCBS Trust/PPO |
$453.60
|
| Rate for Payer: BCN Commercial |
$453.60
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Nomi Health Commercial |
$450.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$477.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.31
|
| Rate for Payer: UHC Core |
$458.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.38 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: BCBS Trust/PPO |
$155.90
|
| Rate for Payer: BCN Commercial |
$155.90
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Nomi Health Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$157.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Medicare |
$49.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.99
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: BCBS MAPPO |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$155.18
|
| Rate for Payer: BCN Medicare Advantage |
$47.19
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.19
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Mclaren Medicaid |
$33.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.55
|
| Rate for Payer: Meridian Medicaid |
$34.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Nomi Health Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PACE Senior Care Partners |
$44.83
|
| Rate for Payer: PACE SWMI |
$47.19
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: PHP Medicare Advantage |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.22
|
| Rate for Payer: Priority Health Medicare |
$47.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.38
|
| Rate for Payer: Railroad Medicare Medicare |
$47.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$157.61
|
| Rate for Payer: UHC Exchange |
$47.19
|
| Rate for Payer: UHC Medicaid |
$33.28
|
| Rate for Payer: UHC Medicare Advantage |
$47.19
|
| Rate for Payer: UHCCP Medicaid |
$33.28
|
| Rate for Payer: VA VA |
$47.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.73 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: Aetna Medicare |
$142.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.45
|
| Rate for Payer: BCBS Complete |
$101.56
|
| Rate for Payer: BCBS MAPPO |
$137.16
|
| Rate for Payer: BCBS Trust/PPO |
$451.05
|
| Rate for Payer: BCN Commercial |
$451.05
|
| Rate for Payer: BCN Medicare Advantage |
$137.16
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.16
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.49
|
| Rate for Payer: Mclaren Medicaid |
$96.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.02
|
| Rate for Payer: Meridian Medicaid |
$101.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Nomi Health Commercial |
$449.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PACE Senior Care Partners |
$130.30
|
| Rate for Payer: PACE SWMI |
$137.16
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: PHP Medicare Advantage |
$137.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$477.33
|
| Rate for Payer: Priority Health Medicare |
$138.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.86
|
| Rate for Payer: Railroad Medicare Medicare |
$137.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.81
|
| Rate for Payer: UHC Core |
$458.12
|
| Rate for Payer: UHC Exchange |
$137.16
|
| Rate for Payer: UHC Medicaid |
$96.73
|
| Rate for Payer: UHC Medicare Advantage |
$137.16
|
| Rate for Payer: UHCCP Medicaid |
$96.73
|
| Rate for Payer: VA VA |
$137.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.49
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$381.86 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: BCBS Trust/PPO |
$453.13
|
| Rate for Payer: BCN Commercial |
$453.13
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Nomi Health Commercial |
$449.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$477.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.81
|
| Rate for Payer: UHC Core |
$458.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.49
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: BCBS Trust/PPO |
$51.10
|
| Rate for Payer: BCN Commercial |
$51.10
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Nomi Health Commercial |
$50.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Core |
$51.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna Medicare |
$16.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.33
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$15.47
|
| Rate for Payer: BCBS Trust/PPO |
$50.86
|
| Rate for Payer: BCN Commercial |
$50.86
|
| Rate for Payer: BCN Medicare Advantage |
$15.47
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.47
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Mclaren Medicaid |
$10.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.24
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Nomi Health Commercial |
$50.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PACE Senior Care Partners |
$14.69
|
| Rate for Payer: PACE SWMI |
$15.47
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: PHP Medicare Advantage |
$15.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.83
|
| Rate for Payer: Priority Health Medicare |
$15.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Core |
$51.66
|
| Rate for Payer: UHC Exchange |
$15.47
|
| Rate for Payer: UHC Medicaid |
$10.91
|
| Rate for Payer: UHC Medicare Advantage |
$15.47
|
| Rate for Payer: UHCCP Medicaid |
$10.91
|
| Rate for Payer: VA VA |
$15.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.09 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: BCBS Trust/PPO |
$265.92
|
| Rate for Payer: BCN Commercial |
$265.92
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Nomi Health Commercial |
$264.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.33
|
| Rate for Payer: UHC Core |
$268.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.48
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.76 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna Medicare |
$83.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.62
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$80.49
|
| Rate for Payer: BCBS Trust/PPO |
$264.69
|
| Rate for Payer: BCN Commercial |
$264.69
|
| Rate for Payer: BCN Medicare Advantage |
$80.49
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.48
|
| Rate for Payer: Mclaren Medicaid |
$56.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.52
|
| Rate for Payer: Meridian Medicaid |
$59.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Nomi Health Commercial |
$264.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PACE Senior Care Partners |
$76.47
|
| Rate for Payer: PACE SWMI |
$80.49
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: PHP Medicare Advantage |
$80.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.11
|
| Rate for Payer: Priority Health Medicare |
$81.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.09
|
| Rate for Payer: Railroad Medicare Medicare |
$80.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.33
|
| Rate for Payer: UHC Core |
$268.84
|
| Rate for Payer: UHC Exchange |
$80.49
|
| Rate for Payer: UHC Medicaid |
$56.76
|
| Rate for Payer: UHC Medicare Advantage |
$80.49
|
| Rate for Payer: UHCCP Medicaid |
$56.76
|
| Rate for Payer: VA VA |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.48
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: BCBS Trust/PPO |
$132.34
|
| Rate for Payer: BCN Commercial |
$132.34
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.01
|
| Rate for Payer: UHC Core |
$133.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.18
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$41.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.08
|
| Rate for Payer: BCBS Complete |
$29.66
|
| Rate for Payer: BCBS MAPPO |
$40.06
|
| Rate for Payer: BCBS Trust/PPO |
$131.73
|
| Rate for Payer: BCN Commercial |
$131.73
|
| Rate for Payer: BCN Medicare Advantage |
$40.06
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.18
|
| Rate for Payer: Mclaren Medicaid |
$28.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.06
|
| Rate for Payer: Meridian Medicaid |
$29.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PACE Senior Care Partners |
$38.06
|
| Rate for Payer: PACE SWMI |
$40.06
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: PHP Medicare Advantage |
$40.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.41
|
| Rate for Payer: Priority Health Medicare |
$40.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.53
|
| Rate for Payer: Railroad Medicare Medicare |
$40.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.01
|
| Rate for Payer: UHC Core |
$133.80
|
| Rate for Payer: UHC Exchange |
$40.06
|
| Rate for Payer: UHC Medicaid |
$28.25
|
| Rate for Payer: UHC Medicare Advantage |
$40.06
|
| Rate for Payer: UHCCP Medicaid |
$28.25
|
| Rate for Payer: VA VA |
$40.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.18
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna Medicare |
$29.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.23
|
| Rate for Payer: BCBS Complete |
$20.87
|
| Rate for Payer: BCBS MAPPO |
$28.18
|
| Rate for Payer: BCBS Trust/PPO |
$92.68
|
| Rate for Payer: BCN Commercial |
$92.68
|
| Rate for Payer: BCN Medicare Advantage |
$28.18
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.18
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.56
|
| Rate for Payer: Mclaren Medicaid |
$19.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.59
|
| Rate for Payer: Meridian Medicaid |
$20.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Nomi Health Commercial |
$92.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PACE Senior Care Partners |
$26.78
|
| Rate for Payer: PACE SWMI |
$28.18
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: PHP Medicare Advantage |
$28.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.08
|
| Rate for Payer: Priority Health Medicare |
$28.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.47
|
| Rate for Payer: Railroad Medicare Medicare |
$28.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.21
|
| Rate for Payer: UHC Core |
$94.14
|
| Rate for Payer: UHC Exchange |
$28.18
|
| Rate for Payer: UHC Medicaid |
$19.88
|
| Rate for Payer: UHC Medicare Advantage |
$28.18
|
| Rate for Payer: UHCCP Medicaid |
$19.88
|
| Rate for Payer: VA VA |
$28.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.56
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: BCBS Trust/PPO |
$93.11
|
| Rate for Payer: BCN Commercial |
$93.11
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Nomi Health Commercial |
$92.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.21
|
| Rate for Payer: UHC Core |
$94.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.56
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.87 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$85.33
|
| Rate for Payer: BCBS Trust/PPO |
$82.91
|
| Rate for Payer: BCN Commercial |
$82.91
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Commercial |
$86.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$90.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Nomi Health Commercial |
$82.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: PHP Commercial |
$85.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.34
|
| Rate for Payer: UHC Core |
$83.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.29
|
|
