|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$147.44
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$132.70 |
| Rate for Payer: Aetna Commercial |
$125.32
|
| Rate for Payer: Aetna Medicare |
$38.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.08
|
| Rate for Payer: BCBS Complete |
$58.98
|
| Rate for Payer: BCBS MAPPO |
$36.86
|
| Rate for Payer: BCBS Trust/PPO |
$121.21
|
| Rate for Payer: BCN Commercial |
$114.63
|
| Rate for Payer: BCN Medicare Advantage |
$36.86
|
| Rate for Payer: Cash Price |
$117.95
|
| Rate for Payer: Cofinity Commercial |
$126.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.86
|
| Rate for Payer: Healthscope Commercial |
$132.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: Nomi Health Commercial |
$120.90
|
| Rate for Payer: PACE Senior Care Partners |
$35.02
|
| Rate for Payer: PACE SWMI |
$36.86
|
| Rate for Payer: PHP Commercial |
$125.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.84
|
| Rate for Payer: Priority Health HMO/PPO |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$37.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.78
|
| Rate for Payer: Railroad Medicare Medicare |
$36.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.75
|
| Rate for Payer: UHC Core |
$123.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.86
|
| Rate for Payer: UHC Exchange |
$36.86
|
| Rate for Payer: UHC Medicare Advantage |
$36.86
|
| Rate for Payer: VA VA |
$36.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.58
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$222.17 |
| Max. Negotiated Rate |
$307.62 |
| Rate for Payer: Aetna Commercial |
$290.53
|
| Rate for Payer: BCBS Trust/PPO |
$279.01
|
| Rate for Payer: BCN Commercial |
$264.14
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$293.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Healthscope Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: Nomi Health Commercial |
$280.28
|
| Rate for Payer: PHP Commercial |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health HMO/PPO |
$297.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.78
|
| Rate for Payer: UHC Core |
$285.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.35
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$307.62 |
| Rate for Payer: Aetna Commercial |
$290.53
|
| Rate for Payer: Aetna Medicare |
$88.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.81
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$85.45
|
| Rate for Payer: BCBS Trust/PPO |
$280.99
|
| Rate for Payer: BCN Commercial |
$265.75
|
| Rate for Payer: BCN Medicare Advantage |
$85.45
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$293.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.45
|
| Rate for Payer: Healthscope Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: Nomi Health Commercial |
$280.28
|
| Rate for Payer: PACE Senior Care Partners |
$81.18
|
| Rate for Payer: PACE SWMI |
$85.45
|
| Rate for Payer: PHP Commercial |
$290.53
|
| Rate for Payer: PHP Medicare Advantage |
$85.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health HMO/PPO |
$297.37
|
| Rate for Payer: Priority Health Medicare |
$86.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.01
|
| Rate for Payer: Railroad Medicare Medicare |
$85.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.78
|
| Rate for Payer: UHC Core |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.45
|
| Rate for Payer: UHC Exchange |
$85.45
|
| Rate for Payer: UHC Medicare Advantage |
$85.45
|
| Rate for Payer: VA VA |
$85.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.35
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: BCBS Trust/PPO |
$246.54
|
| Rate for Payer: BCN Commercial |
$233.40
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.31
|
| Rate for Payer: Priority Health HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.52
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.73 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$78.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.38
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS MAPPO |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$248.29
|
| Rate for Payer: BCN Commercial |
$234.82
|
| Rate for Payer: BCN Medicare Advantage |
$75.50
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.50
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: PACE Senior Care Partners |
$71.73
|
| Rate for Payer: PACE SWMI |
$75.50
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: PHP Medicare Advantage |
$75.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.31
|
| Rate for Payer: Priority Health HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Medicare |
$76.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.35
|
| Rate for Payer: Railroad Medicare Medicare |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.50
|
| Rate for Payer: UHC Exchange |
$75.50
|
| Rate for Payer: UHC Medicare Advantage |
$75.50
|
| Rate for Payer: VA VA |
$75.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.52
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Aetna Medicare |
$24.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.02
|
| Rate for Payer: BCBS Complete |
$38.42
|
| Rate for Payer: BCBS MAPPO |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$74.68
|
| Rate for Payer: BCN Medicare Advantage |
$24.01
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.01
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: Nomi Health Commercial |
$78.76
|
| Rate for Payer: PACE Senior Care Partners |
$22.81
|
| Rate for Payer: PACE SWMI |
$24.01
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: PHP Medicare Advantage |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health HMO/PPO |
$83.56
|
| Rate for Payer: Priority Health Medicare |
$24.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.35
|
| Rate for Payer: Railroad Medicare Medicare |
$24.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.52
|
| Rate for Payer: UHC Core |
$80.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.01
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UHC Medicare Advantage |
$24.01
|
| Rate for Payer: VA VA |
$24.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.43 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: BCBS Trust/PPO |
$78.41
|
| Rate for Payer: BCN Commercial |
$74.23
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: Nomi Health Commercial |
$78.76
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health HMO/PPO |
$83.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.52
|
| Rate for Payer: UHC Core |
$80.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$266.30 |
| Max. Negotiated Rate |
$1,009.14 |
| Rate for Payer: Aetna Commercial |
$953.08
|
| Rate for Payer: Aetna Medicare |
$291.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.40
|
| Rate for Payer: BCBS Complete |
$448.51
|
| Rate for Payer: BCBS MAPPO |
$280.32
|
| Rate for Payer: BCBS Trust/PPO |
$921.80
|
| Rate for Payer: BCN Commercial |
$871.79
|
| Rate for Payer: BCN Medicare Advantage |
$280.32
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$964.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.32
|
| Rate for Payer: Healthscope Commercial |
$1,009.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: Nomi Health Commercial |
$919.44
|
| Rate for Payer: PACE Senior Care Partners |
$266.30
|
| Rate for Payer: PACE SWMI |
$280.32
|
| Rate for Payer: PHP Commercial |
$953.08
|
| Rate for Payer: PHP Medicare Advantage |
$280.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: Priority Health HMO/PPO |
$975.50
|
| Rate for Payer: Priority Health Medicare |
$283.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.25
|
| Rate for Payer: Railroad Medicare Medicare |
$280.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.72
|
| Rate for Payer: UHC Core |
$936.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.32
|
| Rate for Payer: UHC Exchange |
$280.32
|
| Rate for Payer: UHC Medicare Advantage |
$280.32
|
| Rate for Payer: VA VA |
$280.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.95
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.83 |
| Max. Negotiated Rate |
$1,009.14 |
| Rate for Payer: Aetna Commercial |
$953.08
|
| Rate for Payer: BCBS Trust/PPO |
$915.29
|
| Rate for Payer: BCN Commercial |
$866.52
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$964.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Healthscope Commercial |
$1,009.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: Nomi Health Commercial |
$919.44
|
| Rate for Payer: PHP Commercial |
$953.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: Priority Health HMO/PPO |
$975.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.72
|
| Rate for Payer: UHC Core |
$936.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.95
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$818.36 |
| Max. Negotiated Rate |
$1,133.12 |
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.74
|
| Rate for Payer: BCN Commercial |
$972.97
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,082.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Healthscope Commercial |
$1,133.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: Nomi Health Commercial |
$1,032.40
|
| Rate for Payer: PHP Commercial |
$1,070.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,095.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,107.94
|
| Rate for Payer: UHC Core |
$1,051.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.26
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$299.02 |
| Max. Negotiated Rate |
$1,133.12 |
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: Aetna Medicare |
$327.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$393.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$393.44
|
| Rate for Payer: BCBS Complete |
$503.61
|
| Rate for Payer: BCBS MAPPO |
$314.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.04
|
| Rate for Payer: BCN Commercial |
$978.89
|
| Rate for Payer: BCN Medicare Advantage |
$314.76
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,082.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.76
|
| Rate for Payer: Healthscope Commercial |
$1,133.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: Nomi Health Commercial |
$1,032.40
|
| Rate for Payer: PACE Senior Care Partners |
$299.02
|
| Rate for Payer: PACE SWMI |
$314.76
|
| Rate for Payer: PHP Commercial |
$1,070.17
|
| Rate for Payer: PHP Medicare Advantage |
$314.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,095.35
|
| Rate for Payer: Priority Health Medicare |
$317.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$843.54
|
| Rate for Payer: Railroad Medicare Medicare |
$314.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,107.94
|
| Rate for Payer: UHC Core |
$1,051.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.76
|
| Rate for Payer: UHC Exchange |
$314.76
|
| Rate for Payer: UHC Medicare Advantage |
$314.76
|
| Rate for Payer: VA VA |
$314.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.26
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$696.15 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: BCBS Trust/PPO |
$874.26
|
| Rate for Payer: BCN Commercial |
$827.67
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$254.36 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$278.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.69
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS MAPPO |
$267.75
|
| Rate for Payer: BCBS Trust/PPO |
$880.47
|
| Rate for Payer: BCN Commercial |
$832.70
|
| Rate for Payer: BCN Medicare Advantage |
$267.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: PACE Senior Care Partners |
$254.36
|
| Rate for Payer: PACE SWMI |
$267.75
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Medicare |
$270.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.57
|
| Rate for Payer: Railroad Medicare Medicare |
$267.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.75
|
| Rate for Payer: UHC Exchange |
$267.75
|
| Rate for Payer: UHC Medicare Advantage |
$267.75
|
| Rate for Payer: VA VA |
$267.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,823.77 |
| Max. Negotiated Rate |
$5,294.46 |
| Rate for Payer: Aetna Commercial |
$5,000.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,802.07
|
| Rate for Payer: BCN Commercial |
$4,546.17
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Cofinity Commercial |
$5,059.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Healthscope Commercial |
$5,294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,412.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: Nomi Health Commercial |
$4,823.84
|
| Rate for Payer: PHP Commercial |
$5,000.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5,117.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,941.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,176.80
|
| Rate for Payer: UHC Core |
$4,912.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,412.05
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,397.15 |
| Max. Negotiated Rate |
$5,294.46 |
| Rate for Payer: Aetna Commercial |
$5,000.32
|
| Rate for Payer: Aetna Medicare |
$1,529.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,838.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,838.35
|
| Rate for Payer: BCBS Complete |
$2,353.09
|
| Rate for Payer: BCBS MAPPO |
$1,470.68
|
| Rate for Payer: BCBS Trust/PPO |
$4,836.19
|
| Rate for Payer: BCN Commercial |
$4,573.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,470.68
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Cofinity Commercial |
$5,059.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,470.68
|
| Rate for Payer: Healthscope Commercial |
$5,294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,412.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,544.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,691.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: Nomi Health Commercial |
$4,823.84
|
| Rate for Payer: PACE Senior Care Partners |
$1,397.15
|
| Rate for Payer: PACE SWMI |
$1,470.68
|
| Rate for Payer: PHP Commercial |
$5,000.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,470.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5,117.98
|
| Rate for Payer: Priority Health Medicare |
$1,485.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,941.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,470.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,176.80
|
| Rate for Payer: UHC Core |
$4,912.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,470.68
|
| Rate for Payer: UHC Exchange |
$1,470.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,470.68
|
| Rate for Payer: VA VA |
$1,470.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,412.05
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.99 |
| Max. Negotiated Rate |
$1,333.85 |
| Rate for Payer: Aetna Commercial |
$1,259.75
|
| Rate for Payer: Aetna Medicare |
$385.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.14
|
| Rate for Payer: BCBS Complete |
$592.82
|
| Rate for Payer: BCBS MAPPO |
$370.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.40
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: BCN Medicare Advantage |
$370.52
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,274.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.52
|
| Rate for Payer: Healthscope Commercial |
$1,333.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: Nomi Health Commercial |
$1,215.29
|
| Rate for Payer: PACE Senior Care Partners |
$351.99
|
| Rate for Payer: PACE SWMI |
$370.52
|
| Rate for Payer: PHP Commercial |
$1,259.75
|
| Rate for Payer: PHP Medicare Advantage |
$370.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1,289.39
|
| Rate for Payer: Priority Health Medicare |
$374.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$992.98
|
| Rate for Payer: Railroad Medicare Medicare |
$370.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,304.21
|
| Rate for Payer: UHC Core |
$1,237.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.52
|
| Rate for Payer: UHC Exchange |
$370.52
|
| Rate for Payer: UHC Medicare Advantage |
$370.52
|
| Rate for Payer: VA VA |
$370.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.54
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$963.34 |
| Max. Negotiated Rate |
$1,333.85 |
| Rate for Payer: Aetna Commercial |
$1,259.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.81
|
| Rate for Payer: BCN Commercial |
$1,145.34
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,274.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Healthscope Commercial |
$1,333.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: Nomi Health Commercial |
$1,215.29
|
| Rate for Payer: PHP Commercial |
$1,259.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1,289.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$992.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,304.21
|
| Rate for Payer: UHC Core |
$1,237.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.54
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: BCBS Trust/PPO |
$224.81
|
| Rate for Payer: BCN Commercial |
$212.83
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health HMO/PPO |
$239.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.35
|
| Rate for Payer: UHC Core |
$229.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$71.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.06
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: BCBS MAPPO |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$226.41
|
| Rate for Payer: BCN Commercial |
$214.12
|
| Rate for Payer: BCN Medicare Advantage |
$68.85
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.85
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: Nomi Health Commercial |
$225.83
|
| Rate for Payer: PACE Senior Care Partners |
$65.41
|
| Rate for Payer: PACE SWMI |
$68.85
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: PHP Medicare Advantage |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health HMO/PPO |
$239.60
|
| Rate for Payer: Priority Health Medicare |
$69.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.52
|
| Rate for Payer: Railroad Medicare Medicare |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.35
|
| Rate for Payer: UHC Core |
$229.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.85
|
| Rate for Payer: UHC Exchange |
$68.85
|
| Rate for Payer: UHC Medicare Advantage |
$68.85
|
| Rate for Payer: VA VA |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$18.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.99
|
| Rate for Payer: BCBS Complete |
$28.15
|
| Rate for Payer: BCBS MAPPO |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$54.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.60
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: PACE Senior Care Partners |
$16.72
|
| Rate for Payer: PACE SWMI |
$17.60
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO |
$61.23
|
| Rate for Payer: Priority Health Medicare |
$17.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.15
|
| Rate for Payer: Railroad Medicare Medicare |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.93
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.60
|
| Rate for Payer: UHC Exchange |
$17.60
|
| Rate for Payer: UHC Medicare Advantage |
$17.60
|
| Rate for Payer: VA VA |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$54.39
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO |
$61.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.93
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$969.26 |
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna Medicare |
$280.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$336.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$336.55
|
| Rate for Payer: BCBS Complete |
$430.78
|
| Rate for Payer: BCBS MAPPO |
$269.24
|
| Rate for Payer: BCBS Trust/PPO |
$885.36
|
| Rate for Payer: BCN Commercial |
$837.33
|
| Rate for Payer: BCN Medicare Advantage |
$269.24
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$926.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$269.24
|
| Rate for Payer: Healthscope Commercial |
$969.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$807.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: Nomi Health Commercial |
$883.10
|
| Rate for Payer: PACE Senior Care Partners |
$255.78
|
| Rate for Payer: PACE SWMI |
$269.24
|
| Rate for Payer: PHP Commercial |
$915.41
|
| Rate for Payer: PHP Medicare Advantage |
$269.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: Priority Health HMO/PPO |
$936.95
|
| Rate for Payer: Priority Health Medicare |
$271.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$721.56
|
| Rate for Payer: Railroad Medicare Medicare |
$269.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$947.72
|
| Rate for Payer: UHC Core |
$899.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$269.24
|
| Rate for Payer: UHC Exchange |
$269.24
|
| Rate for Payer: UHC Medicare Advantage |
$269.24
|
| Rate for Payer: VA VA |
$269.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$807.71
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$700.02 |
| Max. Negotiated Rate |
$969.26 |
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: BCBS Trust/PPO |
$879.11
|
| Rate for Payer: BCN Commercial |
$832.27
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$926.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Healthscope Commercial |
$969.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$807.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: Nomi Health Commercial |
$883.10
|
| Rate for Payer: PHP Commercial |
$915.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: Priority Health HMO/PPO |
$936.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$721.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$947.72
|
| Rate for Payer: UHC Core |
$899.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$807.71
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.94 |
| Max. Negotiated Rate |
$628.83 |
| Rate for Payer: Aetna Commercial |
$593.90
|
| Rate for Payer: Aetna Medicare |
$181.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.34
|
| Rate for Payer: BCBS Complete |
$279.48
|
| Rate for Payer: BCBS MAPPO |
$174.68
|
| Rate for Payer: BCBS Trust/PPO |
$574.40
|
| Rate for Payer: BCN Commercial |
$543.24
|
| Rate for Payer: BCN Medicare Advantage |
$174.68
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$600.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.68
|
| Rate for Payer: Healthscope Commercial |
$628.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.90
|
| Rate for Payer: Nomi Health Commercial |
$572.93
|
| Rate for Payer: PACE Senior Care Partners |
$165.94
|
| Rate for Payer: PACE SWMI |
$174.68
|
| Rate for Payer: PHP Commercial |
$593.90
|
| Rate for Payer: PHP Medicare Advantage |
$174.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.16
|
| Rate for Payer: Priority Health HMO/PPO |
$607.87
|
| Rate for Payer: Priority Health Medicare |
$176.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.13
|
| Rate for Payer: Railroad Medicare Medicare |
$174.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.86
|
| Rate for Payer: UHC Core |
$583.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.68
|
| Rate for Payer: UHC Exchange |
$174.68
|
| Rate for Payer: UHC Medicare Advantage |
$174.68
|
| Rate for Payer: VA VA |
$174.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.16 |
| Max. Negotiated Rate |
$628.83 |
| Rate for Payer: Aetna Commercial |
$593.90
|
| Rate for Payer: BCBS Trust/PPO |
$570.35
|
| Rate for Payer: BCN Commercial |
$539.96
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$600.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Healthscope Commercial |
$628.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.90
|
| Rate for Payer: Nomi Health Commercial |
$572.93
|
| Rate for Payer: PHP Commercial |
$593.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.16
|
| Rate for Payer: Priority Health HMO/PPO |
$607.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.86
|
| Rate for Payer: UHC Core |
$583.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
