|
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
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,180.62 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: Aetna Medicare |
$1,292.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,553.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,553.44
|
| Rate for Payer: BCBS Complete |
$1,988.41
|
| Rate for Payer: BCBS MAPPO |
$1,242.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,086.68
|
| Rate for Payer: BCN Commercial |
$3,864.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,242.76
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,242.76
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,429.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: Nomi Health Commercial |
$4,076.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,180.62
|
| Rate for Payer: PACE SWMI |
$1,242.76
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,242.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health HMO/PPO |
$4,324.79
|
| Rate for Payer: Priority Health Medicare |
$1,255.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,330.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,242.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,374.50
|
| Rate for Payer: UHC Core |
$4,150.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,242.76
|
| Rate for Payer: UHC Exchange |
$1,242.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,242.76
|
| Rate for Payer: VA VA |
$1,242.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,231.16 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: BCBS Trust/PPO |
$4,057.84
|
| Rate for Payer: BCN Commercial |
$3,841.60
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: Nomi Health Commercial |
$4,076.24
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health HMO/PPO |
$4,324.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,330.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,374.50
|
| Rate for Payer: UHC Core |
$4,150.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$1,246.83 |
| Rate for Payer: Aetna Commercial |
$1,177.56
|
| Rate for Payer: Aetna Medicare |
$360.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$432.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$432.93
|
| Rate for Payer: BCBS Complete |
$554.15
|
| Rate for Payer: BCBS MAPPO |
$346.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,138.91
|
| Rate for Payer: BCN Commercial |
$1,077.13
|
| Rate for Payer: BCN Medicare Advantage |
$346.34
|
| Rate for Payer: Cash Price |
$1,108.30
|
| Rate for Payer: Cofinity Commercial |
$1,191.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.34
|
| Rate for Payer: Healthscope Commercial |
$1,246.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,039.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.56
|
| Rate for Payer: Nomi Health Commercial |
$1,136.00
|
| Rate for Payer: PACE Senior Care Partners |
$329.03
|
| Rate for Payer: PACE SWMI |
$346.34
|
| Rate for Payer: PHP Commercial |
$1,177.56
|
| Rate for Payer: PHP Medicare Advantage |
$346.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,205.27
|
| Rate for Payer: Priority Health Medicare |
$349.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$928.20
|
| Rate for Payer: Railroad Medicare Medicare |
$346.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,219.13
|
| Rate for Payer: UHC Core |
$1,156.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.34
|
| Rate for Payer: UHC Exchange |
$346.34
|
| Rate for Payer: UHC Medicare Advantage |
$346.34
|
| Rate for Payer: VA VA |
$346.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,039.03
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.49 |
| Max. Negotiated Rate |
$1,246.83 |
| Rate for Payer: Aetna Commercial |
$1,177.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.88
|
| Rate for Payer: BCN Commercial |
$1,070.61
|
| Rate for Payer: Cash Price |
$1,108.30
|
| Rate for Payer: Cofinity Commercial |
$1,191.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.30
|
| Rate for Payer: Healthscope Commercial |
$1,246.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,039.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.56
|
| Rate for Payer: Nomi Health Commercial |
$1,136.00
|
| Rate for Payer: PHP Commercial |
$1,177.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,205.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$928.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,219.13
|
| Rate for Payer: UHC Core |
$1,156.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,039.03
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,059.41 |
| Max. Negotiated Rate |
$1,466.87 |
| Rate for Payer: Aetna Commercial |
$1,385.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,330.45
|
| Rate for Payer: BCN Commercial |
$1,259.56
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,401.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Healthscope Commercial |
$1,466.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: Nomi Health Commercial |
$1,336.49
|
| Rate for Payer: PHP Commercial |
$1,385.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,417.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,092.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,434.28
|
| Rate for Payer: UHC Core |
$1,360.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.40
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.09 |
| Max. Negotiated Rate |
$1,466.87 |
| Rate for Payer: Aetna Commercial |
$1,385.38
|
| Rate for Payer: Aetna Medicare |
$423.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$509.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$509.33
|
| Rate for Payer: BCBS Complete |
$651.94
|
| Rate for Payer: BCBS MAPPO |
$407.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.91
|
| Rate for Payer: BCN Commercial |
$1,267.22
|
| Rate for Payer: BCN Medicare Advantage |
$407.46
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,401.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.46
|
| Rate for Payer: Healthscope Commercial |
$1,466.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$468.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: Nomi Health Commercial |
$1,336.49
|
| Rate for Payer: PACE Senior Care Partners |
$387.09
|
| Rate for Payer: PACE SWMI |
$407.46
|
| Rate for Payer: PHP Commercial |
$1,385.38
|
| Rate for Payer: PHP Medicare Advantage |
$407.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,417.98
|
| Rate for Payer: Priority Health Medicare |
$411.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,092.01
|
| Rate for Payer: Railroad Medicare Medicare |
$407.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,434.28
|
| Rate for Payer: UHC Core |
$1,360.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.46
|
| Rate for Payer: UHC Exchange |
$407.46
|
| Rate for Payer: UHC Medicare Advantage |
$407.46
|
| Rate for Payer: VA VA |
$407.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.40
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$182.55 |
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Medicare |
$52.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.38
|
| Rate for Payer: BCBS Complete |
$81.13
|
| Rate for Payer: BCBS MAPPO |
$50.71
|
| Rate for Payer: BCBS Trust/PPO |
$166.75
|
| Rate for Payer: BCN Commercial |
$157.70
|
| Rate for Payer: BCN Medicare Advantage |
$50.71
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$174.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$182.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: Nomi Health Commercial |
$166.32
|
| Rate for Payer: PACE Senior Care Partners |
$48.17
|
| Rate for Payer: PACE SWMI |
$50.71
|
| Rate for Payer: PHP Commercial |
$172.41
|
| Rate for Payer: PHP Medicare Advantage |
$50.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health HMO/PPO |
$176.46
|
| Rate for Payer: Priority Health Medicare |
$51.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.90
|
| Rate for Payer: Railroad Medicare Medicare |
$50.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.49
|
| Rate for Payer: UHC Core |
$169.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.71
|
| Rate for Payer: UHC Exchange |
$50.71
|
| Rate for Payer: UHC Medicare Advantage |
$50.71
|
| Rate for Payer: VA VA |
$50.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.12
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$182.55 |
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: BCBS Trust/PPO |
$165.57
|
| Rate for Payer: BCN Commercial |
$156.75
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$174.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$182.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: Nomi Health Commercial |
$166.32
|
| Rate for Payer: PHP Commercial |
$172.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health HMO/PPO |
$176.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.49
|
| Rate for Payer: UHC Core |
$169.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.12
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna Commercial |
$554.01
|
| Rate for Payer: Aetna Medicare |
$169.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.68
|
| Rate for Payer: BCBS Complete |
$260.71
|
| Rate for Payer: BCBS MAPPO |
$162.94
|
| Rate for Payer: BCBS Trust/PPO |
$535.83
|
| Rate for Payer: BCN Commercial |
$506.76
|
| Rate for Payer: BCN Medicare Advantage |
$162.94
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$560.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.94
|
| Rate for Payer: Healthscope Commercial |
$586.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: Nomi Health Commercial |
$534.46
|
| Rate for Payer: PACE Senior Care Partners |
$154.80
|
| Rate for Payer: PACE SWMI |
$162.94
|
| Rate for Payer: PHP Commercial |
$554.01
|
| Rate for Payer: PHP Medicare Advantage |
$162.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: Priority Health HMO/PPO |
$567.05
|
| Rate for Payer: Priority Health Medicare |
$164.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.69
|
| Rate for Payer: Railroad Medicare Medicare |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.57
|
| Rate for Payer: UHC Core |
$544.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.94
|
| Rate for Payer: UHC Exchange |
$162.94
|
| Rate for Payer: UHC Medicare Advantage |
$162.94
|
| Rate for Payer: VA VA |
$162.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.84
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.66 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna Commercial |
$554.01
|
| Rate for Payer: BCBS Trust/PPO |
$532.05
|
| Rate for Payer: BCN Commercial |
$503.70
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$560.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Healthscope Commercial |
$586.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: Nomi Health Commercial |
$534.46
|
| Rate for Payer: PHP Commercial |
$554.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: Priority Health HMO/PPO |
$567.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.57
|
| Rate for Payer: UHC Core |
$544.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.84
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$151.54
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.29 |
| Max. Negotiated Rate |
$175.43 |
| Rate for Payer: Aetna Commercial |
$165.68
|
| Rate for Payer: Aetna Medicare |
$50.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.91
|
| Rate for Payer: BCBS Complete |
$77.97
|
| Rate for Payer: BCBS MAPPO |
$48.73
|
| Rate for Payer: BCBS Trust/PPO |
$160.24
|
| Rate for Payer: BCN Commercial |
$151.55
|
| Rate for Payer: BCN Medicare Advantage |
$48.73
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$167.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.73
|
| Rate for Payer: Healthscope Commercial |
$175.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: Nomi Health Commercial |
$159.83
|
| Rate for Payer: PACE Senior Care Partners |
$46.29
|
| Rate for Payer: PACE SWMI |
$48.73
|
| Rate for Payer: PHP Commercial |
$165.68
|
| Rate for Payer: PHP Medicare Advantage |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health HMO/PPO |
$169.58
|
| Rate for Payer: Priority Health Medicare |
$49.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.60
|
| Rate for Payer: Railroad Medicare Medicare |
$48.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.53
|
| Rate for Payer: UHC Core |
$162.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.73
|
| Rate for Payer: UHC Exchange |
$48.73
|
| Rate for Payer: UHC Medicare Advantage |
$48.73
|
| Rate for Payer: VA VA |
$48.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.19
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$175.43 |
| Rate for Payer: Aetna Commercial |
$165.68
|
| Rate for Payer: BCBS Trust/PPO |
$159.11
|
| Rate for Payer: BCN Commercial |
$150.63
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$167.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Healthscope Commercial |
$175.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: Nomi Health Commercial |
$159.83
|
| Rate for Payer: PHP Commercial |
$165.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health HMO/PPO |
$169.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.53
|
| Rate for Payer: UHC Core |
$162.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.19
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$606.70 |
| Max. Negotiated Rate |
$2,299.06 |
| Rate for Payer: Aetna Commercial |
$2,171.33
|
| Rate for Payer: Aetna Medicare |
$664.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$798.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$798.28
|
| Rate for Payer: BCBS Complete |
$1,021.80
|
| Rate for Payer: BCBS MAPPO |
$638.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,100.06
|
| Rate for Payer: BCN Commercial |
$1,986.13
|
| Rate for Payer: BCN Medicare Advantage |
$638.63
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$2,196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.63
|
| Rate for Payer: Healthscope Commercial |
$2,299.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,915.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$734.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: Nomi Health Commercial |
$2,094.70
|
| Rate for Payer: PACE Senior Care Partners |
$606.70
|
| Rate for Payer: PACE SWMI |
$638.63
|
| Rate for Payer: PHP Commercial |
$2,171.33
|
| Rate for Payer: PHP Medicare Advantage |
$638.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: Priority Health HMO/PPO |
$2,222.42
|
| Rate for Payer: Priority Health Medicare |
$645.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,711.52
|
| Rate for Payer: Railroad Medicare Medicare |
$638.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,247.97
|
| Rate for Payer: UHC Core |
$2,133.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.63
|
| Rate for Payer: UHC Exchange |
$638.63
|
| Rate for Payer: UHC Medicare Advantage |
$638.63
|
| Rate for Payer: VA VA |
$638.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,915.88
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,660.43 |
| Max. Negotiated Rate |
$2,299.06 |
| Rate for Payer: Aetna Commercial |
$2,171.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.25
|
| Rate for Payer: BCN Commercial |
$1,974.13
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$2,196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Healthscope Commercial |
$2,299.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,915.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: Nomi Health Commercial |
$2,094.70
|
| Rate for Payer: PHP Commercial |
$2,171.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: Priority Health HMO/PPO |
$2,222.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,711.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,247.97
|
| Rate for Payer: UHC Core |
$2,133.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,915.88
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.83 |
| Max. Negotiated Rate |
$2,447.35 |
| Rate for Payer: Aetna Commercial |
$2,311.39
|
| Rate for Payer: Aetna Medicare |
$707.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$849.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$849.78
|
| Rate for Payer: BCBS Complete |
$1,087.71
|
| Rate for Payer: BCBS MAPPO |
$679.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,235.52
|
| Rate for Payer: BCN Commercial |
$2,114.24
|
| Rate for Payer: BCN Medicare Advantage |
$679.82
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$2,338.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.82
|
| Rate for Payer: Healthscope Commercial |
$2,447.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,039.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: Nomi Health Commercial |
$2,229.81
|
| Rate for Payer: PACE Senior Care Partners |
$645.83
|
| Rate for Payer: PACE SWMI |
$679.82
|
| Rate for Payer: PHP Commercial |
$2,311.39
|
| Rate for Payer: PHP Medicare Advantage |
$679.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,365.77
|
| Rate for Payer: Priority Health Medicare |
$686.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,821.92
|
| Rate for Payer: Railroad Medicare Medicare |
$679.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,392.97
|
| Rate for Payer: UHC Core |
$2,270.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.82
|
| Rate for Payer: UHC Exchange |
$679.82
|
| Rate for Payer: UHC Medicare Advantage |
$679.82
|
| Rate for Payer: VA VA |
$679.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,039.46
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,767.53 |
| Max. Negotiated Rate |
$2,447.35 |
| Rate for Payer: Aetna Commercial |
$2,311.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,219.75
|
| Rate for Payer: BCN Commercial |
$2,101.46
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$2,338.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Commercial |
$2,447.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,039.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: Nomi Health Commercial |
$2,229.81
|
| Rate for Payer: PHP Commercial |
$2,311.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,365.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,821.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,392.97
|
| Rate for Payer: UHC Core |
$2,270.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,039.46
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$334.63 |
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: BCBS Trust/PPO |
$303.51
|
| Rate for Payer: BCN Commercial |
$287.33
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$319.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Healthscope Commercial |
$334.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: Nomi Health Commercial |
$304.88
|
| Rate for Payer: PHP Commercial |
$316.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO |
$323.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.19
|
| Rate for Payer: UHC Core |
$310.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.86
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.30 |
| Max. Negotiated Rate |
$334.63 |
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: Aetna Medicare |
$96.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.19
|
| Rate for Payer: BCBS Complete |
$148.72
|
| Rate for Payer: BCBS MAPPO |
$92.95
|
| Rate for Payer: BCBS Trust/PPO |
$305.67
|
| Rate for Payer: BCN Commercial |
$289.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.95
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$319.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.95
|
| Rate for Payer: Healthscope Commercial |
$334.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: Nomi Health Commercial |
$304.88
|
| Rate for Payer: PACE Senior Care Partners |
$88.30
|
| Rate for Payer: PACE SWMI |
$92.95
|
| Rate for Payer: PHP Commercial |
$316.04
|
| Rate for Payer: PHP Medicare Advantage |
$92.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO |
$323.47
|
| Rate for Payer: Priority Health Medicare |
$93.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.11
|
| Rate for Payer: Railroad Medicare Medicare |
$92.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.19
|
| Rate for Payer: UHC Core |
$310.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.95
|
| Rate for Payer: UHC Exchange |
$92.95
|
| Rate for Payer: UHC Medicare Advantage |
$92.95
|
| Rate for Payer: VA VA |
$92.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.86
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.11 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$337.53
|
| Rate for Payer: BCBS Trust/PPO |
$324.14
|
| Rate for Payer: BCN Commercial |
$306.87
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$341.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: Nomi Health Commercial |
$325.61
|
| Rate for Payer: PHP Commercial |
$337.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: Priority Health HMO/PPO |
$345.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.44
|
| Rate for Payer: UHC Core |
$331.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$337.53
|
| Rate for Payer: Aetna Medicare |
$103.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.09
|
| Rate for Payer: BCBS Complete |
$158.84
|
| Rate for Payer: BCBS MAPPO |
$99.27
|
| Rate for Payer: BCBS Trust/PPO |
$326.45
|
| Rate for Payer: BCN Commercial |
$308.74
|
| Rate for Payer: BCN Medicare Advantage |
$99.27
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$341.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.27
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: Nomi Health Commercial |
$325.61
|
| Rate for Payer: PACE Senior Care Partners |
$94.31
|
| Rate for Payer: PACE SWMI |
$99.27
|
| Rate for Payer: PHP Commercial |
$337.53
|
| Rate for Payer: PHP Medicare Advantage |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: Priority Health HMO/PPO |
$345.47
|
| Rate for Payer: Priority Health Medicare |
$100.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.05
|
| Rate for Payer: Railroad Medicare Medicare |
$99.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.44
|
| Rate for Payer: UHC Core |
$331.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.27
|
| Rate for Payer: UHC Exchange |
$99.27
|
| Rate for Payer: UHC Medicare Advantage |
$99.27
|
| Rate for Payer: VA VA |
$99.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.74 |
| Max. Negotiated Rate |
$393.11 |
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: Aetna Medicare |
$113.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.50
|
| Rate for Payer: BCBS Complete |
$174.72
|
| Rate for Payer: BCBS MAPPO |
$109.20
|
| Rate for Payer: BCBS Trust/PPO |
$359.09
|
| Rate for Payer: BCN Commercial |
$339.60
|
| Rate for Payer: BCN Medicare Advantage |
$109.20
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$375.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.20
|
| Rate for Payer: Healthscope Commercial |
$393.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: Nomi Health Commercial |
$358.17
|
| Rate for Payer: PACE Senior Care Partners |
$103.74
|
| Rate for Payer: PACE SWMI |
$109.20
|
| Rate for Payer: PHP Commercial |
$371.27
|
| Rate for Payer: PHP Medicare Advantage |
$109.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: Priority Health HMO/PPO |
$380.01
|
| Rate for Payer: Priority Health Medicare |
$110.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.65
|
| Rate for Payer: Railroad Medicare Medicare |
$109.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.38
|
| Rate for Payer: UHC Core |
$364.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.20
|
| Rate for Payer: UHC Exchange |
$109.20
|
| Rate for Payer: UHC Medicare Advantage |
$109.20
|
| Rate for Payer: VA VA |
$109.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.59
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$283.91 |
| Max. Negotiated Rate |
$393.11 |
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: BCBS Trust/PPO |
$356.55
|
| Rate for Payer: BCN Commercial |
$337.55
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$375.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Healthscope Commercial |
$393.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: Nomi Health Commercial |
$358.17
|
| Rate for Payer: PHP Commercial |
$371.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: Priority Health HMO/PPO |
$380.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.38
|
| Rate for Payer: UHC Core |
$364.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.59
|
|
