|
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 |
$488.83
|
| 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 |
$488.83
|
|
|
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 |
$488.83
|
| 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 |
$488.83
|
|
|
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 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 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
|
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 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 |
$849.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$849.77
|
| 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 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 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 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
|
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
|
|
|
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 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 |
$484.61 |
| 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 |
$484.61
|
| 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 |
$484.61 |
| 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 |
$484.61
|
| 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 |
$46.27
|
| Rate for Payer: BCBS Trust/PPO |
$152.14
|
| Rate for Payer: BCN Commercial |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$46.27
|
| 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 |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.79
|
| 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 |
$46.27
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: PHP Medicare Advantage |
$46.27
|
| 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 |
$46.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.85
|
| Rate for Payer: UHC Core |
$154.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.27
|
| Rate for Payer: UHC Exchange |
$46.27
|
| Rate for Payer: UHC Medicare Advantage |
$46.27
|
| Rate for Payer: VA VA |
$46.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.79
|
|
|
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 |
$138.79
|
| 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 |
$138.79
|
|
|
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 |
$45.49
|
| 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 |
$45.49
|
|
|
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 |
$45.49
|
| 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 |
$45.49
|
|
|
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 |
$236.75
|
| 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 |
$236.75
|
|
