|
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 |
$314.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.04
|
| Rate for Payer: BCN Commercial |
$978.89
|
| Rate for Payer: BCN Medicare Advantage |
$314.75
|
| 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 |
$314.75
|
| 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 |
$314.75
|
| Rate for Payer: PHP Commercial |
$1,070.17
|
| Rate for Payer: PHP Medicare Advantage |
$314.75
|
| 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 |
$314.75
|
| 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 |
$314.75
|
| Rate for Payer: UHC Exchange |
$314.75
|
| Rate for Payer: UHC Medicare Advantage |
$314.75
|
| Rate for Payer: VA VA |
$314.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.26
|
|
|
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 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
|
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 |
$1,111.55
|
| 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 |
$1,111.55
|
|
|
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 |
$370.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.40
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: BCN Medicare Advantage |
$370.51
|
| 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 |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$1,333.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.55
|
| 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 |
$370.51
|
| Rate for Payer: PHP Commercial |
$1,259.75
|
| Rate for Payer: PHP Medicare Advantage |
$370.51
|
| 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 |
$370.51
|
| 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 |
$370.51
|
| Rate for Payer: UHC Exchange |
$370.51
|
| Rate for Payer: UHC Medicare Advantage |
$370.51
|
| Rate for Payer: VA VA |
$370.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.55
|
|
|
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 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 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 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 |
$17.59
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$54.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.59
|
| 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 |
$17.59
|
| 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 |
$17.59
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.59
|
| 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 |
$17.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.93
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.59
|
| Rate for Payer: UHC Exchange |
$17.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: VA VA |
$17.59
|
| 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 |
$969.25 |
| 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 |
$969.25
|
| 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 |
$969.25 |
| 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 |
$969.25
|
| 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 |
$593.89
|
| 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 |
$593.89
|
| 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 |
$593.89
|
| Rate for Payer: PHP Medicare Advantage |
$174.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| 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 |
$454.15 |
| Max. Negotiated Rate |
$628.83 |
| Rate for Payer: Aetna Commercial |
$593.89
|
| 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 |
$593.89
|
| Rate for Payer: Nomi Health Commercial |
$572.93
|
| Rate for Payer: PHP Commercial |
$593.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.15
|
| 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
|
|
|
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
|
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 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 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 |
$105.67
|
| Rate for Payer: BCBS Trust/PPO |
$347.47
|
| Rate for Payer: BCN Commercial |
$328.62
|
| Rate for Payer: BCN Medicare Advantage |
$105.67
|
| 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 |
$105.67
|
| 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 |
$105.67
|
| Rate for Payer: PHP Commercial |
$359.26
|
| Rate for Payer: PHP Medicare Advantage |
$105.67
|
| 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 |
$105.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.94
|
| Rate for Payer: UHC Core |
$352.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.67
|
| Rate for Payer: UHC Exchange |
$105.67
|
| Rate for Payer: UHC Medicare Advantage |
$105.67
|
| Rate for Payer: VA VA |
$105.67
|
| 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
|
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
|
|
