|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.54
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.20
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$199.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$179.93 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: BCBS Trust/PPO |
$163.19
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.93
|
| Rate for Payer: UHC Core |
$166.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.94
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$199.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$179.93 |
| Rate for Payer: Aetna Commercial |
$169.93
|
| Rate for Payer: Aetna Medicare |
$51.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.48
|
| Rate for Payer: BCBS Complete |
$79.97
|
| Rate for Payer: BCBS MAPPO |
$49.98
|
| Rate for Payer: BCBS Trust/PPO |
$164.35
|
| Rate for Payer: BCN Commercial |
$155.44
|
| Rate for Payer: BCN Medicare Advantage |
$49.98
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.98
|
| Rate for Payer: Healthscope Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.93
|
| Rate for Payer: Nomi Health Commercial |
$163.93
|
| Rate for Payer: PACE Senior Care Partners |
$47.48
|
| Rate for Payer: PACE SWMI |
$49.98
|
| Rate for Payer: PHP Commercial |
$169.93
|
| Rate for Payer: PHP Medicare Advantage |
$49.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO |
$173.93
|
| Rate for Payer: Priority Health Medicare |
$50.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.95
|
| Rate for Payer: Railroad Medicare Medicare |
$49.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.93
|
| Rate for Payer: UHC Core |
$166.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.98
|
| Rate for Payer: UHC Exchange |
$49.98
|
| Rate for Payer: UHC Medicare Advantage |
$49.98
|
| Rate for Payer: VA VA |
$49.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.94
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.38 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Aetna Commercial |
$359.26
|
| Rate for Payer: Aetna Medicare |
$109.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.08
|
| Rate for Payer: BCBS Complete |
$169.06
|
| Rate for Payer: BCBS MAPPO |
$105.66
|
| Rate for Payer: BCBS Trust/PPO |
$347.47
|
| Rate for Payer: BCN Commercial |
$328.62
|
| Rate for Payer: BCN Medicare Advantage |
$105.66
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$363.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.66
|
| Rate for Payer: Healthscope Commercial |
$380.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: Nomi Health Commercial |
$346.58
|
| Rate for Payer: PACE Senior Care Partners |
$100.38
|
| Rate for Payer: PACE SWMI |
$105.66
|
| Rate for Payer: PHP Commercial |
$359.26
|
| Rate for Payer: PHP Medicare Advantage |
$105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: Priority Health HMO/PPO |
$367.71
|
| Rate for Payer: Priority Health Medicare |
$106.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.18
|
| Rate for Payer: Railroad Medicare Medicare |
$105.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.94
|
| Rate for Payer: UHC Core |
$352.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.66
|
| Rate for Payer: UHC Exchange |
$105.66
|
| Rate for Payer: UHC Medicare Advantage |
$105.66
|
| Rate for Payer: VA VA |
$105.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.00
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.73 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Aetna Commercial |
$359.26
|
| Rate for Payer: BCBS Trust/PPO |
$345.02
|
| Rate for Payer: BCN Commercial |
$326.63
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$363.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$380.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: Nomi Health Commercial |
$346.58
|
| Rate for Payer: PHP Commercial |
$359.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: Priority Health HMO/PPO |
$367.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.94
|
| Rate for Payer: UHC Core |
$352.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.00
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.46 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Medicare |
$131.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.49
|
| Rate for Payer: BCBS Complete |
$202.87
|
| Rate for Payer: BCBS MAPPO |
$126.80
|
| Rate for Payer: BCBS Trust/PPO |
$416.95
|
| Rate for Payer: BCN Commercial |
$394.33
|
| Rate for Payer: BCN Medicare Advantage |
$126.80
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$436.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.80
|
| Rate for Payer: Healthscope Commercial |
$456.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: Nomi Health Commercial |
$415.89
|
| Rate for Payer: PACE Senior Care Partners |
$120.46
|
| Rate for Payer: PACE SWMI |
$126.80
|
| Rate for Payer: PHP Commercial |
$431.10
|
| Rate for Payer: PHP Medicare Advantage |
$126.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: Priority Health HMO/PPO |
$441.25
|
| Rate for Payer: Priority Health Medicare |
$128.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.81
|
| Rate for Payer: Railroad Medicare Medicare |
$126.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.32
|
| Rate for Payer: UHC Core |
$423.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.80
|
| Rate for Payer: UHC Exchange |
$126.80
|
| Rate for Payer: UHC Medicare Advantage |
$126.80
|
| Rate for Payer: VA VA |
$126.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.38
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.67 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: BCBS Trust/PPO |
$414.01
|
| Rate for Payer: BCN Commercial |
$391.95
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$436.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Healthscope Commercial |
$456.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: Nomi Health Commercial |
$415.89
|
| Rate for Payer: PHP Commercial |
$431.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: Priority Health HMO/PPO |
$441.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.32
|
| Rate for Payer: UHC Core |
$423.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.38
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: BCBS Trust/PPO |
$244.79
|
| Rate for Payer: BCN Commercial |
$231.75
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: Nomi Health Commercial |
$245.90
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: Priority Health HMO/PPO |
$260.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.89
|
| Rate for Payer: UHC Core |
$250.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.91
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.22 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Medicare |
$77.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.71
|
| Rate for Payer: BCBS Complete |
$119.95
|
| Rate for Payer: BCBS MAPPO |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$246.53
|
| Rate for Payer: BCN Commercial |
$233.16
|
| Rate for Payer: BCN Medicare Advantage |
$74.97
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: Nomi Health Commercial |
$245.90
|
| Rate for Payer: PACE Senior Care Partners |
$71.22
|
| Rate for Payer: PACE SWMI |
$74.97
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: PHP Medicare Advantage |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: Priority Health HMO/PPO |
$260.90
|
| Rate for Payer: Priority Health Medicare |
$75.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.92
|
| Rate for Payer: Railroad Medicare Medicare |
$74.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.89
|
| Rate for Payer: UHC Core |
$250.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.97
|
| Rate for Payer: UHC Exchange |
$74.97
|
| Rate for Payer: UHC Medicare Advantage |
$74.97
|
| Rate for Payer: VA VA |
$74.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.91
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.07 |
| Max. Negotiated Rate |
$462.56 |
| Rate for Payer: Aetna Commercial |
$436.87
|
| Rate for Payer: Aetna Medicare |
$133.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.61
|
| Rate for Payer: BCBS Complete |
$205.58
|
| Rate for Payer: BCBS MAPPO |
$128.49
|
| Rate for Payer: BCBS Trust/PPO |
$422.53
|
| Rate for Payer: BCN Commercial |
$399.60
|
| Rate for Payer: BCN Medicare Advantage |
$128.49
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$442.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.49
|
| Rate for Payer: Healthscope Commercial |
$462.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: Nomi Health Commercial |
$421.45
|
| Rate for Payer: PACE Senior Care Partners |
$122.07
|
| Rate for Payer: PACE SWMI |
$128.49
|
| Rate for Payer: PHP Commercial |
$436.87
|
| Rate for Payer: PHP Medicare Advantage |
$128.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: Priority Health HMO/PPO |
$447.15
|
| Rate for Payer: Priority Health Medicare |
$129.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.35
|
| Rate for Payer: Railroad Medicare Medicare |
$128.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.28
|
| Rate for Payer: UHC Core |
$429.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.49
|
| Rate for Payer: UHC Exchange |
$128.49
|
| Rate for Payer: UHC Medicare Advantage |
$128.49
|
| Rate for Payer: VA VA |
$128.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.47
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$334.07 |
| Max. Negotiated Rate |
$462.56 |
| Rate for Payer: Aetna Commercial |
$436.87
|
| Rate for Payer: BCBS Trust/PPO |
$419.55
|
| Rate for Payer: BCN Commercial |
$397.19
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$442.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$462.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: Nomi Health Commercial |
$421.45
|
| Rate for Payer: PHP Commercial |
$436.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: Priority Health HMO/PPO |
$447.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.28
|
| Rate for Payer: UHC Core |
$429.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.47
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$273.51 |
| Max. Negotiated Rate |
$378.71 |
| Rate for Payer: Aetna Commercial |
$357.67
|
| Rate for Payer: BCBS Trust/PPO |
$343.49
|
| Rate for Payer: BCN Commercial |
$325.19
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$361.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Healthscope Commercial |
$378.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: Nomi Health Commercial |
$345.05
|
| Rate for Payer: PHP Commercial |
$357.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: Priority Health HMO/PPO |
$366.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.30
|
| Rate for Payer: UHC Core |
$351.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.59
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$378.71 |
| Rate for Payer: Aetna Commercial |
$357.67
|
| Rate for Payer: Aetna Medicare |
$109.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.50
|
| Rate for Payer: BCBS Complete |
$168.32
|
| Rate for Payer: BCBS MAPPO |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$345.93
|
| Rate for Payer: BCN Commercial |
$327.16
|
| Rate for Payer: BCN Medicare Advantage |
$105.20
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$361.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.20
|
| Rate for Payer: Healthscope Commercial |
$378.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: Nomi Health Commercial |
$345.05
|
| Rate for Payer: PACE Senior Care Partners |
$99.94
|
| Rate for Payer: PACE SWMI |
$105.20
|
| Rate for Payer: PHP Commercial |
$357.67
|
| Rate for Payer: PHP Medicare Advantage |
$105.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: Priority Health HMO/PPO |
$366.09
|
| Rate for Payer: Priority Health Medicare |
$106.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.93
|
| Rate for Payer: Railroad Medicare Medicare |
$105.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.30
|
| Rate for Payer: UHC Core |
$351.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.20
|
| Rate for Payer: UHC Exchange |
$105.20
|
| Rate for Payer: UHC Medicare Advantage |
$105.20
|
| Rate for Payer: VA VA |
$105.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.59
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.38
|
| Rate for Payer: BCBS Complete |
$73.44
|
| Rate for Payer: BCBS MAPPO |
$45.90
|
| Rate for Payer: BCBS Trust/PPO |
$150.94
|
| Rate for Payer: BCN Commercial |
$142.75
|
| Rate for Payer: BCN Medicare Advantage |
$45.90
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: PACE Senior Care Partners |
$43.60
|
| Rate for Payer: PACE SWMI |
$45.90
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: PHP Medicare Advantage |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO |
$159.73
|
| Rate for Payer: Priority Health Medicare |
$46.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.01
|
| Rate for Payer: Railroad Medicare Medicare |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.90
|
| Rate for Payer: UHC Exchange |
$45.90
|
| Rate for Payer: UHC Medicare Advantage |
$45.90
|
| Rate for Payer: VA VA |
$45.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$149.87
|
| Rate for Payer: BCN Commercial |
$141.89
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO |
$159.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$31.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$31.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.28
|
| Rate for Payer: PACE SWMI |
$31.88
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Medicare |
$32.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.88
|
| Rate for Payer: UHC Exchange |
$31.88
|
| Rate for Payer: UHC Medicare Advantage |
$31.88
|
| Rate for Payer: VA VA |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.28 |
| Max. Negotiated Rate |
$232.22 |
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: Aetna Medicare |
$67.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.63
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.12
|
| Rate for Payer: BCN Commercial |
$200.61
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$232.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.32
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: PACE Senior Care Partners |
$61.28
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Commercial |
$219.32
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.71
|
| Rate for Payer: Priority Health HMO/PPO |
$224.48
|
| Rate for Payer: Priority Health Medicare |
$65.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.87
|
| Rate for Payer: Railroad Medicare Medicare |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.06
|
| Rate for Payer: UHC Core |
$215.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Exchange |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$64.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.71 |
| Max. Negotiated Rate |
$232.22 |
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: BCBS Trust/PPO |
$210.62
|
| Rate for Payer: BCN Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.32
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: PHP Commercial |
$219.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.71
|
| Rate for Payer: Priority Health HMO/PPO |
$224.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.06
|
| Rate for Payer: UHC Core |
$215.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$438.82 |
| Max. Negotiated Rate |
$1,662.90 |
| Rate for Payer: Aetna Commercial |
$1,570.52
|
| Rate for Payer: Aetna Medicare |
$480.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$577.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$577.40
|
| Rate for Payer: BCBS Complete |
$739.07
|
| Rate for Payer: BCBS MAPPO |
$461.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.97
|
| Rate for Payer: BCN Commercial |
$1,436.56
|
| Rate for Payer: BCN Medicare Advantage |
$461.92
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,589.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$461.92
|
| Rate for Payer: Healthscope Commercial |
$1,662.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$485.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: Nomi Health Commercial |
$1,515.09
|
| Rate for Payer: PACE Senior Care Partners |
$438.82
|
| Rate for Payer: PACE SWMI |
$461.92
|
| Rate for Payer: PHP Commercial |
$1,570.52
|
| Rate for Payer: PHP Medicare Advantage |
$461.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,607.47
|
| Rate for Payer: Priority Health Medicare |
$466.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,237.94
|
| Rate for Payer: Railroad Medicare Medicare |
$461.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.95
|
| Rate for Payer: UHC Core |
$1,542.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$461.92
|
| Rate for Payer: UHC Exchange |
$461.92
|
| Rate for Payer: UHC Medicare Advantage |
$461.92
|
| Rate for Payer: VA VA |
$461.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.75
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.99 |
| Max. Negotiated Rate |
$1,662.90 |
| Rate for Payer: Aetna Commercial |
$1,570.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,508.25
|
| Rate for Payer: BCN Commercial |
$1,427.88
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,589.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Healthscope Commercial |
$1,662.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: Nomi Health Commercial |
$1,515.09
|
| Rate for Payer: PHP Commercial |
$1,570.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,607.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,237.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.95
|
| Rate for Payer: UHC Core |
$1,542.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.75
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$541.50 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$708.11
|
| Rate for Payer: BCBS Trust/PPO |
$680.04
|
| Rate for Payer: BCN Commercial |
$643.80
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Healthscope Commercial |
$749.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: Nomi Health Commercial |
$683.12
|
| Rate for Payer: PHP Commercial |
$708.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: Priority Health HMO/PPO |
$724.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$558.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.10
|
| Rate for Payer: UHC Core |
$695.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.80
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$708.11
|
| Rate for Payer: Aetna Medicare |
$216.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$260.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$260.33
|
| Rate for Payer: BCBS Complete |
$333.23
|
| Rate for Payer: BCBS MAPPO |
$208.27
|
| Rate for Payer: BCBS Trust/PPO |
$684.87
|
| Rate for Payer: BCN Commercial |
$647.71
|
| Rate for Payer: BCN Medicare Advantage |
$208.27
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.27
|
| Rate for Payer: Healthscope Commercial |
$749.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: Nomi Health Commercial |
$683.12
|
| Rate for Payer: PACE Senior Care Partners |
$197.85
|
| Rate for Payer: PACE SWMI |
$208.27
|
| Rate for Payer: PHP Commercial |
$708.11
|
| Rate for Payer: PHP Medicare Advantage |
$208.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: Priority Health HMO/PPO |
$724.77
|
| Rate for Payer: Priority Health Medicare |
$210.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$558.16
|
| Rate for Payer: Railroad Medicare Medicare |
$208.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.10
|
| Rate for Payer: UHC Core |
$695.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.27
|
| Rate for Payer: UHC Exchange |
$208.27
|
| Rate for Payer: UHC Medicare Advantage |
$208.27
|
| Rate for Payer: VA VA |
$208.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.80
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.52 |
| Max. Negotiated Rate |
$862.16 |
| Rate for Payer: Aetna Commercial |
$814.27
|
| Rate for Payer: Aetna Medicare |
$249.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$299.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$299.36
|
| Rate for Payer: BCBS Complete |
$383.18
|
| Rate for Payer: BCBS MAPPO |
$239.49
|
| Rate for Payer: BCBS Trust/PPO |
$787.54
|
| Rate for Payer: BCN Commercial |
$744.81
|
| Rate for Payer: BCN Medicare Advantage |
$239.49
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$823.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.49
|
| Rate for Payer: Healthscope Commercial |
$862.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: Nomi Health Commercial |
$785.53
|
| Rate for Payer: PACE Senior Care Partners |
$227.52
|
| Rate for Payer: PACE SWMI |
$239.49
|
| Rate for Payer: PHP Commercial |
$814.27
|
| Rate for Payer: PHP Medicare Advantage |
$239.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: Priority Health HMO/PPO |
$833.43
|
| Rate for Payer: Priority Health Medicare |
$241.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.83
|
| Rate for Payer: Railroad Medicare Medicare |
$239.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.00
|
| Rate for Payer: UHC Core |
$799.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.49
|
| Rate for Payer: UHC Exchange |
$239.49
|
| Rate for Payer: UHC Medicare Advantage |
$239.49
|
| Rate for Payer: VA VA |
$239.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.47
|
|
