|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.99 |
| Max. Negotiated Rate |
$484.60 |
| Rate for Payer: Aetna Commercial |
$457.68
|
| Rate for Payer: BCBS Trust/PPO |
$439.54
|
| Rate for Payer: BCN Commercial |
$416.11
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$463.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Healthscope Commercial |
$484.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: Nomi Health Commercial |
$441.53
|
| Rate for Payer: PHP Commercial |
$457.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: Priority Health HMO/PPO |
$468.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.84
|
| Rate for Payer: UHC Core |
$449.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.84
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$484.60 |
| Rate for Payer: Aetna Commercial |
$457.68
|
| Rate for Payer: Aetna Medicare |
$140.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.27
|
| Rate for Payer: BCBS Complete |
$215.38
|
| Rate for Payer: BCBS MAPPO |
$134.61
|
| Rate for Payer: BCBS Trust/PPO |
$442.66
|
| Rate for Payer: BCN Commercial |
$418.64
|
| Rate for Payer: BCN Medicare Advantage |
$134.61
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$463.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.61
|
| Rate for Payer: Healthscope Commercial |
$484.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: Nomi Health Commercial |
$441.53
|
| Rate for Payer: PACE Senior Care Partners |
$127.88
|
| Rate for Payer: PACE SWMI |
$134.61
|
| Rate for Payer: PHP Commercial |
$457.68
|
| Rate for Payer: PHP Medicare Advantage |
$134.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: Priority Health HMO/PPO |
$468.45
|
| Rate for Payer: Priority Health Medicare |
$135.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.76
|
| Rate for Payer: Railroad Medicare Medicare |
$134.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.84
|
| Rate for Payer: UHC Core |
$449.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.61
|
| Rate for Payer: UHC Exchange |
$134.61
|
| Rate for Payer: UHC Medicare Advantage |
$134.61
|
| Rate for Payer: VA VA |
$134.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.84
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.83
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$46.26
|
| Rate for Payer: BCBS Trust/PPO |
$152.14
|
| Rate for Payer: BCN Commercial |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$46.26
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$151.75
|
| Rate for Payer: PACE Senior Care Partners |
$43.95
|
| Rate for Payer: PACE SWMI |
$46.26
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: PHP Medicare Advantage |
$46.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: Priority Health HMO/PPO |
$161.00
|
| Rate for Payer: Priority Health Medicare |
$46.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.99
|
| Rate for Payer: Railroad Medicare Medicare |
$46.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.85
|
| Rate for Payer: UHC Core |
$154.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.26
|
| Rate for Payer: UHC Exchange |
$46.26
|
| Rate for Payer: UHC Medicare Advantage |
$46.26
|
| Rate for Payer: VA VA |
$46.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.80
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.29 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: BCBS Trust/PPO |
$151.06
|
| Rate for Payer: BCN Commercial |
$143.01
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$151.75
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: Priority Health HMO/PPO |
$161.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.85
|
| Rate for Payer: UHC Core |
$154.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.80
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$484.10 |
| Rate for Payer: Aetna Commercial |
$457.21
|
| Rate for Payer: BCBS Trust/PPO |
$439.08
|
| Rate for Payer: BCN Commercial |
$415.68
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$462.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Healthscope Commercial |
$484.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: Nomi Health Commercial |
$441.07
|
| Rate for Payer: PHP Commercial |
$457.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: Priority Health HMO/PPO |
$467.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.34
|
| Rate for Payer: UHC Core |
$449.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.42
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$484.10 |
| Rate for Payer: Aetna Commercial |
$457.21
|
| Rate for Payer: Aetna Medicare |
$139.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.09
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$134.47
|
| Rate for Payer: BCBS Trust/PPO |
$442.20
|
| Rate for Payer: BCN Commercial |
$418.21
|
| Rate for Payer: BCN Medicare Advantage |
$134.47
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$462.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.47
|
| Rate for Payer: Healthscope Commercial |
$484.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: Nomi Health Commercial |
$441.07
|
| Rate for Payer: PACE Senior Care Partners |
$127.75
|
| Rate for Payer: PACE SWMI |
$134.47
|
| Rate for Payer: PHP Commercial |
$457.21
|
| Rate for Payer: PHP Medicare Advantage |
$134.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: Priority Health HMO/PPO |
$467.96
|
| Rate for Payer: Priority Health Medicare |
$135.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.39
|
| Rate for Payer: Railroad Medicare Medicare |
$134.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.34
|
| Rate for Payer: UHC Core |
$449.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.47
|
| Rate for Payer: UHC Exchange |
$134.47
|
| Rate for Payer: UHC Medicare Advantage |
$134.47
|
| Rate for Payer: VA VA |
$134.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.42
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$54.59 |
| Rate for Payer: Aetna Commercial |
$51.56
|
| Rate for Payer: Aetna Medicare |
$15.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.96
|
| Rate for Payer: BCBS Complete |
$24.26
|
| Rate for Payer: BCBS MAPPO |
$15.16
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.16
|
| Rate for Payer: BCN Medicare Advantage |
$15.16
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$52.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$54.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: Nomi Health Commercial |
$49.74
|
| Rate for Payer: PACE Senior Care Partners |
$14.41
|
| Rate for Payer: PACE SWMI |
$15.16
|
| Rate for Payer: PHP Commercial |
$51.56
|
| Rate for Payer: PHP Medicare Advantage |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: Priority Health HMO/PPO |
$52.77
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.64
|
| Rate for Payer: Railroad Medicare Medicare |
$15.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.38
|
| Rate for Payer: UHC Core |
$50.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.16
|
| Rate for Payer: UHC Exchange |
$15.16
|
| Rate for Payer: UHC Medicare Advantage |
$15.16
|
| Rate for Payer: VA VA |
$15.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.50
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.43 |
| Max. Negotiated Rate |
$54.59 |
| Rate for Payer: Aetna Commercial |
$51.56
|
| Rate for Payer: BCBS Trust/PPO |
$49.52
|
| Rate for Payer: BCN Commercial |
$46.88
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$52.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$54.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: Nomi Health Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: Priority Health HMO/PPO |
$52.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.38
|
| Rate for Payer: UHC Core |
$50.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.50
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.18 |
| Max. Negotiated Rate |
$284.09 |
| Rate for Payer: Aetna Commercial |
$268.31
|
| Rate for Payer: BCBS Trust/PPO |
$257.67
|
| Rate for Payer: BCN Commercial |
$243.94
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Healthscope Commercial |
$284.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: Nomi Health Commercial |
$258.84
|
| Rate for Payer: PHP Commercial |
$268.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: Priority Health HMO/PPO |
$274.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.78
|
| Rate for Payer: UHC Core |
$263.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.74
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$284.09 |
| Rate for Payer: Aetna Commercial |
$268.31
|
| Rate for Payer: Aetna Medicare |
$82.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.64
|
| Rate for Payer: BCBS Complete |
$126.26
|
| Rate for Payer: BCBS MAPPO |
$78.92
|
| Rate for Payer: BCBS Trust/PPO |
$259.50
|
| Rate for Payer: BCN Commercial |
$245.43
|
| Rate for Payer: BCN Medicare Advantage |
$78.92
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.92
|
| Rate for Payer: Healthscope Commercial |
$284.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: Nomi Health Commercial |
$258.84
|
| Rate for Payer: PACE Senior Care Partners |
$74.97
|
| Rate for Payer: PACE SWMI |
$78.92
|
| Rate for Payer: PHP Commercial |
$268.31
|
| Rate for Payer: PHP Medicare Advantage |
$78.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: Priority Health HMO/PPO |
$274.62
|
| Rate for Payer: Priority Health Medicare |
$79.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.49
|
| Rate for Payer: Railroad Medicare Medicare |
$78.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.78
|
| Rate for Payer: UHC Core |
$263.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.92
|
| Rate for Payer: UHC Exchange |
$78.92
|
| Rate for Payer: UHC Medicare Advantage |
$78.92
|
| Rate for Payer: VA VA |
$78.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.74
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna Commercial |
$133.54
|
| Rate for Payer: Aetna Medicare |
$40.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.09
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$39.28
|
| Rate for Payer: BCBS Trust/PPO |
$129.15
|
| Rate for Payer: BCN Commercial |
$122.15
|
| Rate for Payer: BCN Medicare Advantage |
$39.28
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.28
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PACE Senior Care Partners |
$37.31
|
| Rate for Payer: PACE SWMI |
$39.28
|
| Rate for Payer: PHP Commercial |
$133.54
|
| Rate for Payer: PHP Medicare Advantage |
$39.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO |
$136.68
|
| Rate for Payer: Priority Health Medicare |
$39.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.26
|
| Rate for Payer: Railroad Medicare Medicare |
$39.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.25
|
| Rate for Payer: UHC Core |
$131.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.28
|
| Rate for Payer: UHC Exchange |
$39.28
|
| Rate for Payer: UHC Medicare Advantage |
$39.28
|
| Rate for Payer: VA VA |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.82
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna Commercial |
$133.54
|
| Rate for Payer: BCBS Trust/PPO |
$128.24
|
| Rate for Payer: BCN Commercial |
$121.41
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PHP Commercial |
$133.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO |
$136.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.25
|
| Rate for Payer: UHC Core |
$131.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.82
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Aetna Commercial |
$93.95
|
| Rate for Payer: Aetna Medicare |
$28.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.54
|
| Rate for Payer: BCBS Complete |
$44.21
|
| Rate for Payer: BCBS MAPPO |
$27.63
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$85.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.63
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.63
|
| Rate for Payer: Healthscope Commercial |
$99.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: PACE Senior Care Partners |
$26.25
|
| Rate for Payer: PACE SWMI |
$27.63
|
| Rate for Payer: PHP Commercial |
$93.95
|
| Rate for Payer: PHP Medicare Advantage |
$27.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health HMO/PPO |
$96.16
|
| Rate for Payer: Priority Health Medicare |
$27.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.06
|
| Rate for Payer: Railroad Medicare Medicare |
$27.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.27
|
| Rate for Payer: UHC Core |
$92.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UHC Medicare Advantage |
$27.63
|
| Rate for Payer: VA VA |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.90
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.84 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Aetna Commercial |
$93.95
|
| Rate for Payer: BCBS Trust/PPO |
$90.23
|
| Rate for Payer: BCN Commercial |
$85.42
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: PHP Commercial |
$93.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health HMO/PPO |
$96.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.27
|
| Rate for Payer: UHC Core |
$92.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.90
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$88.58 |
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: Aetna Medicare |
$25.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.76
|
| Rate for Payer: BCBS Complete |
$39.37
|
| Rate for Payer: BCBS MAPPO |
$24.60
|
| Rate for Payer: BCBS Trust/PPO |
$80.91
|
| Rate for Payer: BCN Commercial |
$76.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.60
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$84.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.60
|
| Rate for Payer: Healthscope Commercial |
$88.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: Nomi Health Commercial |
$80.70
|
| Rate for Payer: PACE Senior Care Partners |
$23.37
|
| Rate for Payer: PACE SWMI |
$24.60
|
| Rate for Payer: PHP Commercial |
$83.66
|
| Rate for Payer: PHP Medicare Advantage |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO |
$85.63
|
| Rate for Payer: Priority Health Medicare |
$24.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.94
|
| Rate for Payer: Railroad Medicare Medicare |
$24.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.61
|
| Rate for Payer: UHC Core |
$82.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.60
|
| Rate for Payer: UHC Exchange |
$24.60
|
| Rate for Payer: UHC Medicare Advantage |
$24.60
|
| Rate for Payer: VA VA |
$24.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.82
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$88.58 |
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: BCBS Trust/PPO |
$80.34
|
| Rate for Payer: BCN Commercial |
$76.06
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$84.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Healthscope Commercial |
$88.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: Nomi Health Commercial |
$80.70
|
| Rate for Payer: PHP Commercial |
$83.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO |
$85.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.61
|
| Rate for Payer: UHC Core |
$82.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.82
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,121.60 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Aetna Commercial |
$2,774.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,664.40
|
| Rate for Payer: BCN Commercial |
$2,522.42
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$2,807.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Healthscope Commercial |
$2,937.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: Nomi Health Commercial |
$2,676.48
|
| Rate for Payer: PHP Commercial |
$2,774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health HMO/PPO |
$2,839.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,186.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,872.32
|
| Rate for Payer: UHC Core |
$2,725.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Aetna Commercial |
$2,774.40
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,020.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$1,305.60
|
| Rate for Payer: BCBS MAPPO |
$816.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.33
|
| Rate for Payer: BCN Commercial |
$2,537.76
|
| Rate for Payer: BCN Medicare Advantage |
$816.00
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$2,807.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$2,937.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$856.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$938.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: Nomi Health Commercial |
$2,676.48
|
| Rate for Payer: PACE Senior Care Partners |
$775.20
|
| Rate for Payer: PACE SWMI |
$816.00
|
| Rate for Payer: PHP Commercial |
$2,774.40
|
| Rate for Payer: PHP Medicare Advantage |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health HMO/PPO |
$2,839.68
|
| Rate for Payer: Priority Health Medicare |
$824.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,186.88
|
| Rate for Payer: Railroad Medicare Medicare |
$816.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,872.32
|
| Rate for Payer: UHC Core |
$2,725.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.00
|
| Rate for Payer: UHC Exchange |
$816.00
|
| Rate for Payer: UHC Medicare Advantage |
$816.00
|
| Rate for Payer: VA VA |
$816.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,016.68
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,960.84 |
| Max. Negotiated Rate |
$2,715.01 |
| Rate for Payer: Aetna Commercial |
$2,564.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,462.52
|
| Rate for Payer: BCN Commercial |
$2,331.29
|
| Rate for Payer: Cash Price |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,594.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,413.34
|
| Rate for Payer: Healthscope Commercial |
$2,715.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,262.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.18
|
| Rate for Payer: Nomi Health Commercial |
$2,473.68
|
| Rate for Payer: PHP Commercial |
$2,564.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,624.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,021.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,654.68
|
| Rate for Payer: UHC Core |
$2,518.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,262.51
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,016.68
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$716.46 |
| Max. Negotiated Rate |
$2,715.01 |
| Rate for Payer: Aetna Commercial |
$2,564.18
|
| Rate for Payer: Aetna Medicare |
$784.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$942.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$942.71
|
| Rate for Payer: BCBS Complete |
$1,206.67
|
| Rate for Payer: BCBS MAPPO |
$754.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,480.01
|
| Rate for Payer: BCN Commercial |
$2,345.47
|
| Rate for Payer: BCN Medicare Advantage |
$754.17
|
| Rate for Payer: Cash Price |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,594.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,413.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$754.17
|
| Rate for Payer: Healthscope Commercial |
$2,715.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,262.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$791.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$867.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.18
|
| Rate for Payer: Nomi Health Commercial |
$2,473.68
|
| Rate for Payer: PACE Senior Care Partners |
$716.46
|
| Rate for Payer: PACE SWMI |
$754.17
|
| Rate for Payer: PHP Commercial |
$2,564.18
|
| Rate for Payer: PHP Medicare Advantage |
$754.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,624.51
|
| Rate for Payer: Priority Health Medicare |
$761.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,021.18
|
| Rate for Payer: Railroad Medicare Medicare |
$754.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,654.68
|
| Rate for Payer: UHC Core |
$2,518.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$754.17
|
| Rate for Payer: UHC Exchange |
$754.17
|
| Rate for Payer: UHC Medicare Advantage |
$754.17
|
| Rate for Payer: VA VA |
$754.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,262.51
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$1,803.19 |
| Rate for Payer: Aetna Commercial |
$1,703.01
|
| Rate for Payer: Aetna Medicare |
$520.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$626.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$626.11
|
| Rate for Payer: BCBS Complete |
$801.42
|
| Rate for Payer: BCBS MAPPO |
$500.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,647.11
|
| Rate for Payer: BCN Commercial |
$1,557.75
|
| Rate for Payer: BCN Medicare Advantage |
$500.88
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,723.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.88
|
| Rate for Payer: Healthscope Commercial |
$1,803.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,502.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$576.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: Nomi Health Commercial |
$1,642.90
|
| Rate for Payer: PACE Senior Care Partners |
$475.84
|
| Rate for Payer: PACE SWMI |
$500.88
|
| Rate for Payer: PHP Commercial |
$1,703.01
|
| Rate for Payer: PHP Medicare Advantage |
$500.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,743.08
|
| Rate for Payer: Priority Health Medicare |
$505.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,342.37
|
| Rate for Payer: Railroad Medicare Medicare |
$500.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,763.12
|
| Rate for Payer: UHC Core |
$1,672.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.88
|
| Rate for Payer: UHC Exchange |
$500.88
|
| Rate for Payer: UHC Medicare Advantage |
$500.88
|
| Rate for Payer: VA VA |
$500.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,502.66
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,302.30 |
| Max. Negotiated Rate |
$1,803.19 |
| Rate for Payer: Aetna Commercial |
$1,703.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.49
|
| Rate for Payer: BCN Commercial |
$1,548.34
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,723.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Healthscope Commercial |
$1,803.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,502.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: Nomi Health Commercial |
$1,642.90
|
| Rate for Payer: PHP Commercial |
$1,703.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,743.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,342.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,763.12
|
| Rate for Payer: UHC Core |
$1,672.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,502.66
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: PACE Senior Care Partners |
$11.39
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO |
$41.71
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.96
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.13
|
| Rate for Payer: BCN Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO |
$41.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.96
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.51
|
| Rate for Payer: BCN Commercial |
$27.94
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$31.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$32.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: Nomi Health Commercial |
$29.64
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health HMO/PPO |
$31.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.81
|
| Rate for Payer: UHC Core |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
