|
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
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$586.95 |
| Max. Negotiated Rate |
$2,996.35 |
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: Aetna Medicare |
$865.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,040.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,040.40
|
| Rate for Payer: BCBS Complete |
$616.25
|
| Rate for Payer: BCBS MAPPO |
$832.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,737.00
|
| Rate for Payer: BCN Commercial |
$2,737.00
|
| Rate for Payer: BCN Medicare Advantage |
$832.32
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.32
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,496.96
|
| Rate for Payer: Mclaren Medicaid |
$586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$873.94
|
| Rate for Payer: Meridian Medicaid |
$616.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$957.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$915.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Nomi Health Commercial |
$2,730.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PACE Senior Care Partners |
$790.70
|
| Rate for Payer: PACE SWMI |
$832.32
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: PHP Medicare Advantage |
$832.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,896.47
|
| Rate for Payer: Priority Health Medicare |
$840.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,317.18
|
| Rate for Payer: Railroad Medicare Medicare |
$832.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,929.77
|
| Rate for Payer: UHC Core |
$2,779.95
|
| Rate for Payer: UHC Exchange |
$832.32
|
| Rate for Payer: UHC Medicaid |
$586.95
|
| Rate for Payer: UHC Medicare Advantage |
$832.32
|
| Rate for Payer: UHCCP Medicaid |
$586.95
|
| Rate for Payer: VA VA |
$832.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,496.96
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,317.18 |
| Max. Negotiated Rate |
$2,996.35 |
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,749.65
|
| Rate for Payer: BCN Commercial |
$2,749.65
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,496.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Nomi Health Commercial |
$2,730.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,896.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,317.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,929.77
|
| Rate for Payer: UHC Core |
$2,779.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,496.96
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$542.48 |
| Max. Negotiated Rate |
$2,769.31 |
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: Aetna Medicare |
$800.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$961.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$961.57
|
| Rate for Payer: BCBS Complete |
$569.55
|
| Rate for Payer: BCBS MAPPO |
$769.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,529.61
|
| Rate for Payer: BCN Commercial |
$2,529.61
|
| Rate for Payer: BCN Medicare Advantage |
$769.25
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.25
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,307.76
|
| Rate for Payer: Mclaren Medicaid |
$542.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$807.72
|
| Rate for Payer: Meridian Medicaid |
$569.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$884.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$846.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Nomi Health Commercial |
$2,523.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PACE Senior Care Partners |
$730.79
|
| Rate for Payer: PACE SWMI |
$769.25
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: PHP Medicare Advantage |
$769.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,677.00
|
| Rate for Payer: Priority Health Medicare |
$776.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,141.60
|
| Rate for Payer: Railroad Medicare Medicare |
$769.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,707.77
|
| Rate for Payer: UHC Core |
$2,569.30
|
| Rate for Payer: UHC Exchange |
$769.25
|
| Rate for Payer: UHC Medicaid |
$542.48
|
| Rate for Payer: UHC Medicare Advantage |
$769.25
|
| Rate for Payer: UHCCP Medicaid |
$542.48
|
| Rate for Payer: VA VA |
$769.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,307.76
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,141.60 |
| Max. Negotiated Rate |
$2,769.31 |
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,541.30
|
| Rate for Payer: BCN Commercial |
$2,541.30
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,307.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Nomi Health Commercial |
$2,523.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,677.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,141.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,707.77
|
| Rate for Payer: UHC Core |
$2,569.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,307.76
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,422.35 |
| Max. Negotiated Rate |
$1,839.25 |
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,687.82
|
| Rate for Payer: BCN Commercial |
$1,687.82
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,532.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Nomi Health Commercial |
$1,675.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,777.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,422.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,798.38
|
| Rate for Payer: UHC Core |
$1,706.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,532.71
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.29 |
| Max. Negotiated Rate |
$1,839.25 |
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: Aetna Medicare |
$531.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$638.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$638.63
|
| Rate for Payer: BCBS Complete |
$378.27
|
| Rate for Payer: BCBS MAPPO |
$510.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.05
|
| Rate for Payer: BCN Commercial |
$1,680.05
|
| Rate for Payer: BCN Medicare Advantage |
$510.90
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.90
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,532.71
|
| Rate for Payer: Mclaren Medicaid |
$360.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.45
|
| Rate for Payer: Meridian Medicaid |
$378.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$587.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$561.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Nomi Health Commercial |
$1,675.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PACE Senior Care Partners |
$485.36
|
| Rate for Payer: PACE SWMI |
$510.90
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: PHP Medicare Advantage |
$510.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,777.94
|
| Rate for Payer: Priority Health Medicare |
$516.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,422.35
|
| Rate for Payer: Railroad Medicare Medicare |
$510.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,798.38
|
| Rate for Payer: UHC Core |
$1,706.41
|
| Rate for Payer: UHC Exchange |
$510.90
|
| Rate for Payer: UHC Medicaid |
$360.29
|
| Rate for Payer: UHC Medicare Advantage |
$510.90
|
| Rate for Payer: UHCCP Medicaid |
$360.29
|
| Rate for Payer: VA VA |
$510.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,532.71
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$12.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS MAPPO |
$12.22
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: BCN Medicare Advantage |
$12.22
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.22
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.67
|
| Rate for Payer: Mclaren Medicaid |
$8.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.84
|
| Rate for Payer: Meridian Medicaid |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PACE Senior Care Partners |
$11.61
|
| Rate for Payer: PACE SWMI |
$12.22
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: PHP Medicare Advantage |
$12.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.54
|
| Rate for Payer: Priority Health Medicare |
$12.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.03
|
| Rate for Payer: Railroad Medicare Medicare |
$12.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.03
|
| Rate for Payer: UHC Core |
$40.83
|
| Rate for Payer: UHC Exchange |
$12.22
|
| Rate for Payer: UHC Medicaid |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$12.22
|
| Rate for Payer: UHCCP Medicaid |
$8.62
|
| Rate for Payer: VA VA |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.67
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.39
|
| Rate for Payer: BCN Commercial |
$40.39
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.03
|
| Rate for Payer: UHC Core |
$40.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.67
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: BCBS Trust/PPO |
$30.45
|
| Rate for Payer: BCN Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Nomi Health Commercial |
$30.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.45
|
| Rate for Payer: UHC Core |
$30.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.65
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.52
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$30.31
|
| Rate for Payer: BCN Commercial |
$30.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.22
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.65
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.68
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Nomi Health Commercial |
$30.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PACE Senior Care Partners |
$8.76
|
| Rate for Payer: PACE SWMI |
$9.22
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: PHP Medicare Advantage |
$9.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.08
|
| Rate for Payer: Priority Health Medicare |
$9.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.66
|
| Rate for Payer: Railroad Medicare Medicare |
$9.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.45
|
| Rate for Payer: UHC Core |
$30.79
|
| Rate for Payer: UHC Exchange |
$9.22
|
| Rate for Payer: UHC Medicaid |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$9.22
|
| Rate for Payer: UHCCP Medicaid |
$6.50
|
| Rate for Payer: VA VA |
$9.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.65
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: Aetna Medicare |
$39.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.02
|
| Rate for Payer: BCBS Complete |
$27.85
|
| Rate for Payer: BCBS MAPPO |
$37.62
|
| Rate for Payer: BCBS Trust/PPO |
$123.70
|
| Rate for Payer: BCN Commercial |
$123.70
|
| Rate for Payer: BCN Medicare Advantage |
$37.62
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.85
|
| Rate for Payer: Mclaren Medicaid |
$26.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.50
|
| Rate for Payer: Meridian Medicaid |
$27.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Nomi Health Commercial |
$123.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PACE Senior Care Partners |
$35.74
|
| Rate for Payer: PACE SWMI |
$37.62
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: PHP Medicare Advantage |
$37.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.91
|
| Rate for Payer: Priority Health Medicare |
$37.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.73
|
| Rate for Payer: Railroad Medicare Medicare |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.41
|
| Rate for Payer: UHC Core |
$125.64
|
| Rate for Payer: UHC Exchange |
$37.62
|
| Rate for Payer: UHC Medicaid |
$26.53
|
| Rate for Payer: UHC Medicare Advantage |
$37.62
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: VA VA |
$37.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.85
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.73 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: BCBS Trust/PPO |
$124.27
|
| Rate for Payer: BCN Commercial |
$124.27
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Nomi Health Commercial |
$123.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.41
|
| Rate for Payer: UHC Core |
$125.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.85
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.99 |
| Max. Negotiated Rate |
$311.36 |
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: Aetna Medicare |
$89.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.11
|
| Rate for Payer: BCBS Complete |
$64.04
|
| Rate for Payer: BCBS MAPPO |
$86.49
|
| Rate for Payer: BCBS Trust/PPO |
$284.41
|
| Rate for Payer: BCN Commercial |
$284.41
|
| Rate for Payer: BCN Medicare Advantage |
$86.49
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.46
|
| Rate for Payer: Mclaren Medicaid |
$60.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.81
|
| Rate for Payer: Meridian Medicaid |
$64.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Nomi Health Commercial |
$283.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PACE Senior Care Partners |
$82.16
|
| Rate for Payer: PACE SWMI |
$86.49
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: PHP Medicare Advantage |
$86.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.98
|
| Rate for Payer: Priority Health Medicare |
$87.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.78
|
| Rate for Payer: Railroad Medicare Medicare |
$86.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.44
|
| Rate for Payer: UHC Core |
$288.87
|
| Rate for Payer: UHC Exchange |
$86.49
|
| Rate for Payer: UHC Medicaid |
$60.99
|
| Rate for Payer: UHC Medicare Advantage |
$86.49
|
| Rate for Payer: UHCCP Medicaid |
$60.99
|
| Rate for Payer: VA VA |
$86.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.46
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.78 |
| Max. Negotiated Rate |
$311.36 |
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: BCBS Trust/PPO |
$285.72
|
| Rate for Payer: BCN Commercial |
$285.72
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Nomi Health Commercial |
$283.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.44
|
| Rate for Payer: UHC Core |
$288.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.46
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$443.17 |
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.68
|
| Rate for Payer: BCN Commercial |
$406.68
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Nomi Health Commercial |
$403.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$428.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.32
|
| Rate for Payer: UHC Core |
$411.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.31
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.81 |
| Max. Negotiated Rate |
$443.17 |
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: Aetna Medicare |
$128.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.88
|
| Rate for Payer: BCBS Complete |
$91.15
|
| Rate for Payer: BCBS MAPPO |
$123.10
|
| Rate for Payer: BCBS Trust/PPO |
$404.81
|
| Rate for Payer: BCN Commercial |
$404.81
|
| Rate for Payer: BCN Medicare Advantage |
$123.10
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.10
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.31
|
| Rate for Payer: Mclaren Medicaid |
$86.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.26
|
| Rate for Payer: Meridian Medicaid |
$91.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Nomi Health Commercial |
$403.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PACE Senior Care Partners |
$116.95
|
| Rate for Payer: PACE SWMI |
$123.10
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: PHP Medicare Advantage |
$123.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$428.40
|
| Rate for Payer: Priority Health Medicare |
$124.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.72
|
| Rate for Payer: Railroad Medicare Medicare |
$123.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.32
|
| Rate for Payer: UHC Core |
$411.16
|
| Rate for Payer: UHC Exchange |
$123.10
|
| Rate for Payer: UHC Medicaid |
$86.81
|
| Rate for Payer: UHC Medicare Advantage |
$123.10
|
| Rate for Payer: UHCCP Medicaid |
$86.81
|
| Rate for Payer: VA VA |
$123.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.31
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,361.71
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$416.37 |
| Max. Negotiated Rate |
$2,125.54 |
| Rate for Payer: Aetna Commercial |
$2,007.45
|
| Rate for Payer: Aetna Medicare |
$614.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$738.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$738.03
|
| Rate for Payer: BCBS Complete |
$437.15
|
| Rate for Payer: BCBS MAPPO |
$590.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,941.56
|
| Rate for Payer: BCN Commercial |
$1,941.56
|
| Rate for Payer: BCN Medicare Advantage |
$590.43
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cofinity Commercial |
$2,031.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.43
|
| Rate for Payer: Healthscope Commercial |
$2,125.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.28
|
| Rate for Payer: Mclaren Medicaid |
$416.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.95
|
| Rate for Payer: Meridian Medicaid |
$437.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$678.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$649.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.45
|
| Rate for Payer: Nomi Health Commercial |
$1,936.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,771.28
|
| Rate for Payer: PACE Senior Care Partners |
$560.91
|
| Rate for Payer: PACE SWMI |
$590.43
|
| Rate for Payer: PHP Commercial |
$2,007.45
|
| Rate for Payer: PHP Medicare Advantage |
$590.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$416.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,054.69
|
| Rate for Payer: Priority Health Medicare |
$596.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,643.75
|
| Rate for Payer: Railroad Medicare Medicare |
$590.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,078.30
|
| Rate for Payer: UHC Core |
$1,972.03
|
| Rate for Payer: UHC Exchange |
$590.43
|
| Rate for Payer: UHC Medicaid |
$416.37
|
| Rate for Payer: UHC Medicare Advantage |
$590.43
|
| Rate for Payer: UHCCP Medicaid |
$416.37
|
| Rate for Payer: VA VA |
$590.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.28
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,361.71
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.75 |
| Max. Negotiated Rate |
$2,125.54 |
| Rate for Payer: Aetna Commercial |
$2,007.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.54
|
| Rate for Payer: BCN Commercial |
$1,950.54
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cofinity Commercial |
$2,031.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.37
|
| Rate for Payer: Healthscope Commercial |
$2,125.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.45
|
| Rate for Payer: Nomi Health Commercial |
$1,936.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,771.28
|
| Rate for Payer: PHP Commercial |
$2,007.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,054.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,643.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,078.30
|
| Rate for Payer: UHC Core |
$1,972.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.28
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$156.10
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: BCBS Trust/PPO |
$128.92
|
| Rate for Payer: BCN Commercial |
$128.92
|
| Rate for Payer: Cash Price |
$124.88
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.88
|
| Rate for Payer: Healthscope Commercial |
$140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: Nomi Health Commercial |
$128.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.08
|
| Rate for Payer: PHP Commercial |
$132.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.37
|
| Rate for Payer: UHC Core |
$130.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.08
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$156.10
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$40.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.78
|
| Rate for Payer: BCBS Complete |
$28.89
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.33
|
| Rate for Payer: BCN Commercial |
$128.33
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.88
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.08
|
| Rate for Payer: Mclaren Medicaid |
$27.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.98
|
| Rate for Payer: Meridian Medicaid |
$28.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: Nomi Health Commercial |
$128.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.08
|
| Rate for Payer: PACE Senior Care Partners |
$37.07
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.69
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.81
|
| Rate for Payer: Priority Health Medicare |
$39.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.65
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.37
|
| Rate for Payer: UHC Core |
$130.34
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicaid |
$27.52
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: UHCCP Medicaid |
$27.52
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.08
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$228.69
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$205.82 |
| Rate for Payer: Aetna Commercial |
$194.39
|
| Rate for Payer: Aetna Medicare |
$59.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.47
|
| Rate for Payer: BCBS Complete |
$42.33
|
| Rate for Payer: BCBS MAPPO |
$57.17
|
| Rate for Payer: BCBS Trust/PPO |
$188.01
|
| Rate for Payer: BCN Commercial |
$188.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.17
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cofinity Commercial |
$196.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.17
|
| Rate for Payer: Healthscope Commercial |
$205.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.52
|
| Rate for Payer: Mclaren Medicaid |
$40.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.03
|
| Rate for Payer: Meridian Medicaid |
$42.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.39
|
| Rate for Payer: Nomi Health Commercial |
$187.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.52
|
| Rate for Payer: PACE Senior Care Partners |
$54.31
|
| Rate for Payer: PACE SWMI |
$57.17
|
| Rate for Payer: PHP Commercial |
$194.39
|
| Rate for Payer: PHP Medicare Advantage |
$57.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.96
|
| Rate for Payer: Priority Health Medicare |
$57.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.17
|
| Rate for Payer: Railroad Medicare Medicare |
$57.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.25
|
| Rate for Payer: UHC Core |
$190.96
|
| Rate for Payer: UHC Exchange |
$57.17
|
| Rate for Payer: UHC Medicaid |
$40.32
|
| Rate for Payer: UHC Medicare Advantage |
$57.17
|
| Rate for Payer: UHCCP Medicaid |
$40.32
|
| Rate for Payer: VA VA |
$57.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.52
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$228.69
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$205.82 |
| Rate for Payer: Aetna Commercial |
$194.39
|
| Rate for Payer: BCBS Trust/PPO |
$188.88
|
| Rate for Payer: BCN Commercial |
$188.88
|
| Rate for Payer: Cash Price |
$182.95
|
| Rate for Payer: Cofinity Commercial |
$196.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.95
|
| Rate for Payer: Healthscope Commercial |
$205.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.39
|
| Rate for Payer: Nomi Health Commercial |
$187.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.52
|
| Rate for Payer: PHP Commercial |
$194.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.25
|
| Rate for Payer: UHC Core |
$190.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.52
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,822.59
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$1,640.33 |
| Rate for Payer: Aetna Commercial |
$1,549.20
|
| Rate for Payer: Aetna Medicare |
$473.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$569.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$569.56
|
| Rate for Payer: BCBS Complete |
$337.36
|
| Rate for Payer: BCBS MAPPO |
$455.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.35
|
| Rate for Payer: BCN Commercial |
$1,498.35
|
| Rate for Payer: BCN Medicare Advantage |
$455.65
|
| Rate for Payer: Cash Price |
$1,458.07
|
| Rate for Payer: Cofinity Commercial |
$1,567.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,458.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.65
|
| Rate for Payer: Healthscope Commercial |
$1,640.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,366.94
|
| Rate for Payer: Mclaren Medicaid |
$321.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.43
|
| Rate for Payer: Meridian Medicaid |
$337.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$523.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$501.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,549.20
|
| Rate for Payer: Nomi Health Commercial |
$1,494.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.94
|
| Rate for Payer: PACE Senior Care Partners |
$432.87
|
| Rate for Payer: PACE SWMI |
$455.65
|
| Rate for Payer: PHP Commercial |
$1,549.20
|
| Rate for Payer: PHP Medicare Advantage |
$455.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,585.65
|
| Rate for Payer: Priority Health Medicare |
$460.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,268.52
|
| Rate for Payer: Railroad Medicare Medicare |
$455.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,603.88
|
| Rate for Payer: UHC Core |
$1,521.86
|
| Rate for Payer: UHC Exchange |
$455.65
|
| Rate for Payer: UHC Medicaid |
$321.32
|
| Rate for Payer: UHC Medicare Advantage |
$455.65
|
| Rate for Payer: UHCCP Medicaid |
$321.32
|
| Rate for Payer: VA VA |
$455.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,366.94
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,822.59
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,268.52 |
| Max. Negotiated Rate |
$1,640.33 |
| Rate for Payer: Aetna Commercial |
$1,549.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.28
|
| Rate for Payer: BCN Commercial |
$1,505.28
|
| Rate for Payer: Cash Price |
$1,458.07
|
| Rate for Payer: Cofinity Commercial |
$1,567.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,458.07
|
| Rate for Payer: Healthscope Commercial |
$1,640.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,366.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,549.20
|
| Rate for Payer: Nomi Health Commercial |
$1,494.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.94
|
| Rate for Payer: PHP Commercial |
$1,549.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,585.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,268.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,603.88
|
| Rate for Payer: UHC Core |
$1,521.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,366.94
|
|
