|
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
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.11 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna Commercial |
$133.53
|
| 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 |
$117.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.53
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PHP Commercial |
$133.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| 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 |
$117.83
|
|
|
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 |
$133.53
|
| 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 |
$39.27
|
| Rate for Payer: BCBS Trust/PPO |
$129.15
|
| Rate for Payer: BCN Commercial |
$122.15
|
| Rate for Payer: BCN Medicare Advantage |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.83
|
| 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 |
$133.53
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PACE Senior Care Partners |
$37.31
|
| Rate for Payer: PACE SWMI |
$39.27
|
| Rate for Payer: PHP Commercial |
$133.53
|
| Rate for Payer: PHP Medicare Advantage |
$39.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| 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 |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.25
|
| Rate for Payer: UHC Core |
$131.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.27
|
| Rate for Payer: UHC Exchange |
$39.27
|
| Rate for Payer: UHC Medicare Advantage |
$39.27
|
| Rate for Payer: VA VA |
$39.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.83
|
|
|
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 |
$24.61
|
| Rate for Payer: BCBS Trust/PPO |
$80.91
|
| Rate for Payer: BCN Commercial |
$76.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.61
|
| 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 |
$24.61
|
| Rate for Payer: Healthscope Commercial |
$88.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.81
|
| 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 |
$24.61
|
| Rate for Payer: PHP Commercial |
$83.66
|
| Rate for Payer: PHP Medicare Advantage |
$24.61
|
| 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 |
$24.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.61
|
| Rate for Payer: UHC Core |
$82.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.61
|
| Rate for Payer: UHC Exchange |
$24.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.61
|
| Rate for Payer: VA VA |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.81
|
|
|
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 |
$73.81
|
| 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 |
$73.81
|
|
|
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
|
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 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
|
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 |
$1,502.65
|
| 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 |
$1,502.65
|
|
|
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 |
$1,502.65
|
| 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 |
$1,502.65
|
|
|
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 |
$35.95
|
| 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 |
$35.95
|
|
|
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 |
$35.95
|
| 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 |
$35.95
|
|
|
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 |
$32.53 |
| 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 |
$32.53
|
| 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
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.30
|
| Rate for Payer: BCBS Complete |
$14.46
|
| Rate for Payer: BCBS MAPPO |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.11
|
| Rate for Payer: BCN Medicare Advantage |
$9.04
|
| 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: Health Alliance Plan Medicare Advantage |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: Nomi Health Commercial |
$29.64
|
| Rate for Payer: PACE Senior Care Partners |
$8.59
|
| Rate for Payer: PACE SWMI |
$9.04
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicare Advantage |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health HMO/PPO |
$31.45
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.81
|
| Rate for Payer: UHC Core |
$30.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.04
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UHC Medicare Advantage |
$9.04
|
| Rate for Payer: VA VA |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna Medicare |
$38.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.10
|
| Rate for Payer: BCBS Complete |
$59.01
|
| Rate for Payer: BCBS MAPPO |
$36.88
|
| Rate for Payer: BCBS Trust/PPO |
$121.28
|
| Rate for Payer: BCN Commercial |
$114.70
|
| Rate for Payer: BCN Medicare Advantage |
$36.88
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.88
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: PACE Senior Care Partners |
$35.04
|
| Rate for Payer: PACE SWMI |
$36.88
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: PHP Medicare Advantage |
$36.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO |
$128.34
|
| Rate for Payer: Priority Health Medicare |
$37.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.84
|
| Rate for Payer: Railroad Medicare Medicare |
$36.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.82
|
| Rate for Payer: UHC Core |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.88
|
| Rate for Payer: UHC Exchange |
$36.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.88
|
| Rate for Payer: VA VA |
$36.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: BCBS Trust/PPO |
$120.42
|
| Rate for Payer: BCN Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO |
$128.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.82
|
| Rate for Payer: UHC Core |
$123.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: BCBS Trust/PPO |
$276.86
|
| Rate for Payer: BCN Commercial |
$262.11
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO |
$295.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.47
|
| Rate for Payer: UHC Core |
$283.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.38
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Medicare |
$88.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.99
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: BCBS MAPPO |
$84.79
|
| Rate for Payer: BCBS Trust/PPO |
$278.83
|
| Rate for Payer: BCN Commercial |
$263.70
|
| Rate for Payer: BCN Medicare Advantage |
$84.79
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: PACE Senior Care Partners |
$80.55
|
| Rate for Payer: PACE SWMI |
$84.79
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: PHP Medicare Advantage |
$84.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO |
$295.08
|
| Rate for Payer: Priority Health Medicare |
$85.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.24
|
| Rate for Payer: Railroad Medicare Medicare |
$84.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.47
|
| Rate for Payer: UHC Core |
$283.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.79
|
| Rate for Payer: UHC Exchange |
$84.79
|
| Rate for Payer: UHC Medicare Advantage |
$84.79
|
| Rate for Payer: VA VA |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.38
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.79 |
| Max. Negotiated Rate |
$434.48 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: BCBS Trust/PPO |
$394.07
|
| Rate for Payer: BCN Commercial |
$373.07
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO |
$419.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.82
|
| Rate for Payer: UHC Core |
$403.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.06
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.65 |
| Max. Negotiated Rate |
$434.48 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: Aetna Medicare |
$125.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.86
|
| Rate for Payer: BCBS Complete |
$193.10
|
| Rate for Payer: BCBS MAPPO |
$120.69
|
| Rate for Payer: BCBS Trust/PPO |
$396.87
|
| Rate for Payer: BCN Commercial |
$375.34
|
| Rate for Payer: BCN Medicare Advantage |
$120.69
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: PACE Senior Care Partners |
$114.65
|
| Rate for Payer: PACE SWMI |
$120.69
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: PHP Medicare Advantage |
$120.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO |
$419.99
|
| Rate for Payer: Priority Health Medicare |
$121.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.44
|
| Rate for Payer: Railroad Medicare Medicare |
$120.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.82
|
| Rate for Payer: UHC Core |
$403.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.69
|
| Rate for Payer: UHC Exchange |
$120.69
|
| Rate for Payer: UHC Medicare Advantage |
$120.69
|
| Rate for Payer: VA VA |
$120.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.06
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$549.91 |
| Max. Negotiated Rate |
$2,083.86 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: Aetna Medicare |
$602.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.56
|
| Rate for Payer: BCBS Complete |
$926.16
|
| Rate for Payer: BCBS MAPPO |
$578.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.49
|
| Rate for Payer: BCN Commercial |
$1,800.22
|
| Rate for Payer: BCN Medicare Advantage |
$578.85
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.85
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,736.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$607.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: PACE Senior Care Partners |
$549.91
|
| Rate for Payer: PACE SWMI |
$578.85
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: PHP Medicare Advantage |
$578.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,014.40
|
| Rate for Payer: Priority Health Medicare |
$584.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,551.32
|
| Rate for Payer: Railroad Medicare Medicare |
$578.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,037.55
|
| Rate for Payer: UHC Core |
$1,933.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.85
|
| Rate for Payer: UHC Exchange |
$578.85
|
| Rate for Payer: UHC Medicare Advantage |
$578.85
|
| Rate for Payer: VA VA |
$578.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,736.55
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.01 |
| Max. Negotiated Rate |
$2,083.86 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.06
|
| Rate for Payer: BCN Commercial |
$1,789.34
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,736.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,014.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,551.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,037.55
|
| Rate for Payer: UHC Core |
$1,933.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,736.55
|
|
