|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$52.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.39
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$43.11
|
| Rate for Payer: BCN Commercial |
$40.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.11
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.77
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: PACE Senior Care Partners |
$12.45
|
| Rate for Payer: PACE SWMI |
$13.11
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: PHP Medicare Advantage |
$13.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health HMO/PPO |
$45.62
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.15
|
| Rate for Payer: UHC Core |
$43.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.11
|
| Rate for Payer: UHC Exchange |
$13.11
|
| Rate for Payer: UHC Medicare Advantage |
$13.11
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$13.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: BCBS Trust/PPO |
$46.86
|
| Rate for Payer: BCN Commercial |
$44.36
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO |
$49.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$47.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: Aetna Medicare |
$14.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.94
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$47.19
|
| Rate for Payer: BCN Commercial |
$44.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.35
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.35
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.07
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.63
|
| Rate for Payer: PACE SWMI |
$14.35
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: PHP Medicare Advantage |
$14.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO |
$49.94
|
| Rate for Payer: Priority Health Medicare |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$47.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.35
|
| Rate for Payer: UHC Exchange |
$14.35
|
| Rate for Payer: UHC Medicare Advantage |
$14.35
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$14.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$972.10
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$631.87 |
| Max. Negotiated Rate |
$874.89 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: BCBS Trust/PPO |
$793.53
|
| Rate for Payer: BCN Commercial |
$751.24
|
| Rate for Payer: Cash Price |
$777.68
|
| Rate for Payer: Cofinity Commercial |
$836.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.68
|
| Rate for Payer: Healthscope Commercial |
$874.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.28
|
| Rate for Payer: Nomi Health Commercial |
$797.12
|
| Rate for Payer: PHP Commercial |
$826.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.87
|
| Rate for Payer: Priority Health HMO/PPO |
$845.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.45
|
| Rate for Payer: UHC Core |
$811.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.08
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$972.10
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.87 |
| Max. Negotiated Rate |
$874.89 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: Aetna Medicare |
$252.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.78
|
| Rate for Payer: BCBS Complete |
$388.84
|
| Rate for Payer: BCBS MAPPO |
$243.03
|
| Rate for Payer: BCBS Trust/PPO |
$799.16
|
| Rate for Payer: BCN Commercial |
$755.81
|
| Rate for Payer: BCN Medicare Advantage |
$243.03
|
| Rate for Payer: Cash Price |
$777.68
|
| Rate for Payer: Cofinity Commercial |
$836.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.03
|
| Rate for Payer: Healthscope Commercial |
$874.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.28
|
| Rate for Payer: Nomi Health Commercial |
$797.12
|
| Rate for Payer: PACE Senior Care Partners |
$230.87
|
| Rate for Payer: PACE SWMI |
$243.03
|
| Rate for Payer: PHP Commercial |
$826.28
|
| Rate for Payer: PHP Medicare Advantage |
$243.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.87
|
| Rate for Payer: Priority Health HMO/PPO |
$845.73
|
| Rate for Payer: Priority Health Medicare |
$245.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.31
|
| Rate for Payer: Railroad Medicare Medicare |
$243.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.45
|
| Rate for Payer: UHC Core |
$811.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.03
|
| Rate for Payer: UHC Exchange |
$243.03
|
| Rate for Payer: UHC Medicare Advantage |
$243.03
|
| Rate for Payer: VA VA |
$243.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.08
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$596.14
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.29
|
| Rate for Payer: BCBS Complete |
$238.46
|
| Rate for Payer: BCBS MAPPO |
$149.03
|
| Rate for Payer: BCBS Trust/PPO |
$490.09
|
| Rate for Payer: BCN Commercial |
$463.50
|
| Rate for Payer: BCN Medicare Advantage |
$149.03
|
| Rate for Payer: Cash Price |
$476.91
|
| Rate for Payer: Cofinity Commercial |
$512.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.03
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.72
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PACE Senior Care Partners |
$141.58
|
| Rate for Payer: PACE SWMI |
$149.03
|
| Rate for Payer: PHP Commercial |
$506.72
|
| Rate for Payer: PHP Medicare Advantage |
$149.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.49
|
| Rate for Payer: Priority Health HMO/PPO |
$518.64
|
| Rate for Payer: Priority Health Medicare |
$150.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.41
|
| Rate for Payer: Railroad Medicare Medicare |
$149.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.60
|
| Rate for Payer: UHC Core |
$497.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.03
|
| Rate for Payer: UHC Exchange |
$149.03
|
| Rate for Payer: UHC Medicare Advantage |
$149.03
|
| Rate for Payer: VA VA |
$149.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$596.14
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: BCBS Trust/PPO |
$486.63
|
| Rate for Payer: BCN Commercial |
$460.70
|
| Rate for Payer: Cash Price |
$476.91
|
| Rate for Payer: Cofinity Commercial |
$512.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.72
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PHP Commercial |
$506.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.49
|
| Rate for Payer: Priority Health HMO/PPO |
$518.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.60
|
| Rate for Payer: UHC Core |
$497.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,466.73
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$348.35 |
| Max. Negotiated Rate |
$1,320.06 |
| Rate for Payer: Aetna Commercial |
$1,246.72
|
| Rate for Payer: Aetna Medicare |
$381.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.35
|
| Rate for Payer: BCBS Complete |
$586.69
|
| Rate for Payer: BCBS MAPPO |
$366.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.80
|
| Rate for Payer: BCN Commercial |
$1,140.38
|
| Rate for Payer: BCN Medicare Advantage |
$366.68
|
| Rate for Payer: Cash Price |
$1,173.38
|
| Rate for Payer: Cofinity Commercial |
$1,261.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.68
|
| Rate for Payer: Healthscope Commercial |
$1,320.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,246.72
|
| Rate for Payer: Nomi Health Commercial |
$1,202.72
|
| Rate for Payer: PACE Senior Care Partners |
$348.35
|
| Rate for Payer: PACE SWMI |
$366.68
|
| Rate for Payer: PHP Commercial |
$1,246.72
|
| Rate for Payer: PHP Medicare Advantage |
$366.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,276.06
|
| Rate for Payer: Priority Health Medicare |
$370.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$982.71
|
| Rate for Payer: Railroad Medicare Medicare |
$366.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,290.72
|
| Rate for Payer: UHC Core |
$1,224.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.68
|
| Rate for Payer: UHC Exchange |
$366.68
|
| Rate for Payer: UHC Medicare Advantage |
$366.68
|
| Rate for Payer: VA VA |
$366.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.05
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,466.73
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$953.37 |
| Max. Negotiated Rate |
$1,320.06 |
| Rate for Payer: Aetna Commercial |
$1,246.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.29
|
| Rate for Payer: BCN Commercial |
$1,133.49
|
| Rate for Payer: Cash Price |
$1,173.38
|
| Rate for Payer: Cofinity Commercial |
$1,261.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.38
|
| Rate for Payer: Healthscope Commercial |
$1,320.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,246.72
|
| Rate for Payer: Nomi Health Commercial |
$1,202.72
|
| Rate for Payer: PHP Commercial |
$1,246.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,276.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$982.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,290.72
|
| Rate for Payer: UHC Core |
$1,224.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.05
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$329.81
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$296.83 |
| Rate for Payer: Aetna Commercial |
$280.34
|
| Rate for Payer: BCBS Trust/PPO |
$269.22
|
| Rate for Payer: BCN Commercial |
$254.88
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$283.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Healthscope Commercial |
$296.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: PHP Commercial |
$280.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.38
|
| Rate for Payer: Priority Health HMO/PPO |
$286.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.23
|
| Rate for Payer: UHC Core |
$275.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.36
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$329.81
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$296.83 |
| Rate for Payer: Aetna Commercial |
$280.34
|
| Rate for Payer: Aetna Medicare |
$85.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.07
|
| Rate for Payer: BCBS Complete |
$131.92
|
| Rate for Payer: BCBS MAPPO |
$82.45
|
| Rate for Payer: BCBS Trust/PPO |
$271.14
|
| Rate for Payer: BCN Commercial |
$256.43
|
| Rate for Payer: BCN Medicare Advantage |
$82.45
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$283.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.45
|
| Rate for Payer: Healthscope Commercial |
$296.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: PACE Senior Care Partners |
$78.33
|
| Rate for Payer: PACE SWMI |
$82.45
|
| Rate for Payer: PHP Commercial |
$280.34
|
| Rate for Payer: PHP Medicare Advantage |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.38
|
| Rate for Payer: Priority Health HMO/PPO |
$286.93
|
| Rate for Payer: Priority Health Medicare |
$83.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.97
|
| Rate for Payer: Railroad Medicare Medicare |
$82.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.23
|
| Rate for Payer: UHC Core |
$275.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.45
|
| Rate for Payer: UHC Exchange |
$82.45
|
| Rate for Payer: UHC Medicare Advantage |
$82.45
|
| Rate for Payer: VA VA |
$82.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.36
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$132.50
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Aetna Commercial |
$112.62
|
| Rate for Payer: BCBS Trust/PPO |
$108.16
|
| Rate for Payer: BCN Commercial |
$102.40
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cofinity Commercial |
$113.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$119.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.62
|
| Rate for Payer: Nomi Health Commercial |
$108.65
|
| Rate for Payer: PHP Commercial |
$112.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.12
|
| Rate for Payer: Priority Health HMO/PPO |
$115.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.60
|
| Rate for Payer: UHC Core |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.38
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$132.50
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Aetna Commercial |
$112.62
|
| Rate for Payer: Aetna Medicare |
$34.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.41
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$33.12
|
| Rate for Payer: BCBS Trust/PPO |
$108.93
|
| Rate for Payer: BCN Commercial |
$103.02
|
| Rate for Payer: BCN Medicare Advantage |
$33.12
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cofinity Commercial |
$113.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.12
|
| Rate for Payer: Healthscope Commercial |
$119.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.62
|
| Rate for Payer: Nomi Health Commercial |
$108.65
|
| Rate for Payer: PACE Senior Care Partners |
$31.47
|
| Rate for Payer: PACE SWMI |
$33.12
|
| Rate for Payer: PHP Commercial |
$112.62
|
| Rate for Payer: PHP Medicare Advantage |
$33.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.12
|
| Rate for Payer: Priority Health HMO/PPO |
$115.28
|
| Rate for Payer: Priority Health Medicare |
$33.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.78
|
| Rate for Payer: Railroad Medicare Medicare |
$33.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.60
|
| Rate for Payer: UHC Core |
$110.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.12
|
| Rate for Payer: UHC Exchange |
$33.12
|
| Rate for Payer: UHC Medicare Advantage |
$33.12
|
| Rate for Payer: VA VA |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.38
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,497.14
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$1,347.43 |
| Rate for Payer: Aetna Commercial |
$1,272.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.12
|
| Rate for Payer: BCN Commercial |
$1,156.99
|
| Rate for Payer: Cash Price |
$1,197.71
|
| Rate for Payer: Cofinity Commercial |
$1,287.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,197.71
|
| Rate for Payer: Healthscope Commercial |
$1,347.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,122.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,272.57
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: PHP Commercial |
$1,272.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.14
|
| Rate for Payer: Priority Health HMO/PPO |
$1,302.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,003.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,317.48
|
| Rate for Payer: UHC Core |
$1,250.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,122.86
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,497.14
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.57 |
| Max. Negotiated Rate |
$1,347.43 |
| Rate for Payer: Aetna Commercial |
$1,272.57
|
| Rate for Payer: Aetna Medicare |
$389.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.86
|
| Rate for Payer: BCBS Complete |
$598.86
|
| Rate for Payer: BCBS MAPPO |
$374.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.80
|
| Rate for Payer: BCN Commercial |
$1,164.03
|
| Rate for Payer: BCN Medicare Advantage |
$374.29
|
| Rate for Payer: Cash Price |
$1,197.71
|
| Rate for Payer: Cofinity Commercial |
$1,287.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,197.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.29
|
| Rate for Payer: Healthscope Commercial |
$1,347.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,122.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$430.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,272.57
|
| Rate for Payer: Nomi Health Commercial |
$1,227.65
|
| Rate for Payer: PACE Senior Care Partners |
$355.57
|
| Rate for Payer: PACE SWMI |
$374.29
|
| Rate for Payer: PHP Commercial |
$1,272.57
|
| Rate for Payer: PHP Medicare Advantage |
$374.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.14
|
| Rate for Payer: Priority Health HMO/PPO |
$1,302.51
|
| Rate for Payer: Priority Health Medicare |
$378.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,003.08
|
| Rate for Payer: Railroad Medicare Medicare |
$374.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,317.48
|
| Rate for Payer: UHC Core |
$1,250.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.29
|
| Rate for Payer: UHC Exchange |
$374.29
|
| Rate for Payer: UHC Medicare Advantage |
$374.29
|
| Rate for Payer: VA VA |
$374.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,122.86
|
|
|
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 ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$147.44
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$132.70 |
| Rate for Payer: Aetna Commercial |
$125.32
|
| Rate for Payer: BCBS Trust/PPO |
$120.36
|
| Rate for Payer: BCN Commercial |
$113.94
|
| 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: Healthscope Commercial |
$132.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: Nomi Health Commercial |
$120.90
|
| Rate for Payer: PHP Commercial |
$125.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.84
|
| Rate for Payer: Priority Health HMO/PPO |
$128.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.75
|
| Rate for Payer: UHC Core |
$123.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.58
|
|
|
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 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 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 |
$226.51
|
| 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 |
$226.51
|
|
|
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 |
$226.51
|
| 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 |
$226.51
|
|
|
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 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 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
|
|
