|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna American Axle |
$61.21
|
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.21
|
| Rate for Payer: BCBS Complete |
$37.67
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Cofinity Commercial |
$65.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.34
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$6.26
|
| Rate for Payer: Priority Health SBD |
$59.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.52
|
| Rate for Payer: UHC Exchange |
$10.43
|
| Rate for Payer: UMR Bronson Commercial |
$34.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.63
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$94.17
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna American Axle |
$61.21
|
| Rate for Payer: Aetna Commercial |
$80.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.21
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cofinity Commercial |
$65.92
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.34
|
| Rate for Payer: Healthscope Commercial |
$84.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.04
|
| Rate for Payer: PHP Commercial |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health SBD |
$59.33
|
| Rate for Payer: UMR Bronson Commercial |
$41.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.63
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,099.28
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.68 |
| Max. Negotiated Rate |
$989.35 |
| Rate for Payer: Aetna American Axle |
$714.53
|
| Rate for Payer: Aetna Commercial |
$934.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.53
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cofinity Commercial |
$945.38
|
| Rate for Payer: Cofinity Commercial |
$769.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$879.42
|
| Rate for Payer: Healthscope Commercial |
$989.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$769.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$824.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$934.39
|
| Rate for Payer: PHP Commercial |
$934.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.50
|
| Rate for Payer: Priority Health SBD |
$692.55
|
| Rate for Payer: UMR Bronson Commercial |
$483.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$824.46
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,099.28
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.73 |
| Max. Negotiated Rate |
$1,723.57 |
| Rate for Payer: Aetna American Axle |
$714.53
|
| Rate for Payer: Aetna Commercial |
$934.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.53
|
| Rate for Payer: BCBS Complete |
$439.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,723.57
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cash Price |
$879.42
|
| Rate for Payer: Cofinity Commercial |
$945.38
|
| Rate for Payer: Cofinity Commercial |
$769.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$879.42
|
| Rate for Payer: Healthscope Commercial |
$989.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$769.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$824.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$934.39
|
| Rate for Payer: PHP Commercial |
$934.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.55
|
| Rate for Payer: Priority Health Narrow Network |
$446.04
|
| Rate for Payer: Priority Health SBD |
$692.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.04
|
| Rate for Payer: UHC Exchange |
$636.70
|
| Rate for Payer: UMR Bronson Commercial |
$406.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$824.46
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,234.33
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$456.70 |
| Max. Negotiated Rate |
$1,935.37 |
| Rate for Payer: Aetna American Axle |
$802.31
|
| Rate for Payer: Aetna Commercial |
$1,049.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.31
|
| Rate for Payer: BCBS Complete |
$493.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.37
|
| Rate for Payer: Cash Price |
$987.46
|
| Rate for Payer: Cash Price |
$987.46
|
| Rate for Payer: Cofinity Commercial |
$1,061.52
|
| Rate for Payer: Cofinity Commercial |
$864.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.46
|
| Rate for Payer: Healthscope Commercial |
$1,110.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$864.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
| Rate for Payer: PHP Commercial |
$1,049.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.07
|
| Rate for Payer: Priority Health Narrow Network |
$500.86
|
| Rate for Payer: Priority Health SBD |
$777.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.98
|
| Rate for Payer: UHC Exchange |
$726.65
|
| Rate for Payer: UMR Bronson Commercial |
$456.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.75
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,234.33
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$543.11 |
| Max. Negotiated Rate |
$1,110.90 |
| Rate for Payer: Aetna American Axle |
$802.31
|
| Rate for Payer: Aetna Commercial |
$1,049.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.31
|
| Rate for Payer: Cash Price |
$987.46
|
| Rate for Payer: Cofinity Commercial |
$1,061.52
|
| Rate for Payer: Cofinity Commercial |
$864.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.46
|
| Rate for Payer: Healthscope Commercial |
$1,110.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$864.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$925.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.18
|
| Rate for Payer: PHP Commercial |
$1,049.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.03
|
| Rate for Payer: Priority Health SBD |
$777.63
|
| Rate for Payer: UMR Bronson Commercial |
$543.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$925.75
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna American Axle |
$682.50
|
| Rate for Payer: Aetna Commercial |
$892.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.50
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$735.00
|
| Rate for Payer: Cofinity Commercial |
$903.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$840.00
|
| Rate for Payer: Healthscope Commercial |
$945.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$735.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
| Rate for Payer: PHP Commercial |
$892.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
| Rate for Payer: Priority Health SBD |
$661.50
|
| Rate for Payer: UMR Bronson Commercial |
$462.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$787.50
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$1,504.56 |
| Rate for Payer: Aetna American Axle |
$682.50
|
| Rate for Payer: Aetna Commercial |
$892.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.50
|
| Rate for Payer: BCBS Complete |
$420.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,504.56
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$735.00
|
| Rate for Payer: Cofinity Commercial |
$903.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$840.00
|
| Rate for Payer: Healthscope Commercial |
$945.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$735.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$892.50
|
| Rate for Payer: PHP Commercial |
$892.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.00
|
| Rate for Payer: Priority Health SBD |
$661.50
|
| Rate for Payer: UMR Bronson Commercial |
$388.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$787.50
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,767.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,133.93 |
| Max. Negotiated Rate |
$5,190.64 |
| Rate for Payer: Aetna American Axle |
$3,748.80
|
| Rate for Payer: Aetna Commercial |
$4,902.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.80
|
| Rate for Payer: BCBS Complete |
$2,306.95
|
| Rate for Payer: Cash Price |
$4,613.90
|
| Rate for Payer: Cofinity Commercial |
$4,037.17
|
| Rate for Payer: Cofinity Commercial |
$4,959.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,613.90
|
| Rate for Payer: Healthscope Commercial |
$5,190.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,037.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,325.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
| Rate for Payer: PHP Commercial |
$4,902.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
| Rate for Payer: Priority Health SBD |
$3,633.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,133.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,325.54
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,767.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,537.65 |
| Max. Negotiated Rate |
$5,190.64 |
| Rate for Payer: Aetna American Axle |
$3,748.80
|
| Rate for Payer: Aetna Commercial |
$4,902.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.80
|
| Rate for Payer: Cash Price |
$4,613.90
|
| Rate for Payer: Cofinity Commercial |
$4,037.17
|
| Rate for Payer: Cofinity Commercial |
$4,959.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,613.90
|
| Rate for Payer: Healthscope Commercial |
$5,190.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,037.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,325.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,902.27
|
| Rate for Payer: PHP Commercial |
$4,902.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.17
|
| Rate for Payer: Priority Health SBD |
$3,633.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,537.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,325.54
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$537.61 |
| Max. Negotiated Rate |
$2,244.90 |
| Rate for Payer: Aetna American Axle |
$944.45
|
| Rate for Payer: Aetna Commercial |
$1,235.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.45
|
| Rate for Payer: BCBS Complete |
$581.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.90
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Cofinity Commercial |
$1,017.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.40
|
| Rate for Payer: Healthscope Commercial |
$1,307.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
| Rate for Payer: PHP Commercial |
$1,235.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.19
|
| Rate for Payer: Priority Health Narrow Network |
$580.95
|
| Rate for Payer: Priority Health SBD |
$915.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.04
|
| Rate for Payer: UHC Exchange |
$757.53
|
| Rate for Payer: UMR Bronson Commercial |
$537.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.75
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$639.32 |
| Max. Negotiated Rate |
$1,307.70 |
| Rate for Payer: Aetna American Axle |
$944.45
|
| Rate for Payer: Aetna Commercial |
$1,235.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.45
|
| Rate for Payer: Cash Price |
$1,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,017.10
|
| Rate for Payer: Cofinity Commercial |
$1,249.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.40
|
| Rate for Payer: Healthscope Commercial |
$1,307.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,235.05
|
| Rate for Payer: PHP Commercial |
$1,235.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.10
|
| Rate for Payer: Priority Health SBD |
$915.39
|
| Rate for Payer: UMR Bronson Commercial |
$639.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.75
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna American Axle |
$175.50
|
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.50
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Cofinity Commercial |
$189.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.00
|
| Rate for Payer: Healthscope Commercial |
$243.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
| Rate for Payer: PHP Commercial |
$229.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health SBD |
$170.10
|
| Rate for Payer: UMR Bronson Commercial |
$118.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.50
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$1,504.56 |
| Rate for Payer: Aetna American Axle |
$175.50
|
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.50
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,504.56
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$189.00
|
| Rate for Payer: Cofinity Commercial |
$232.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.00
|
| Rate for Payer: Healthscope Commercial |
$243.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.50
|
| Rate for Payer: PHP Commercial |
$229.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health SBD |
$170.10
|
| Rate for Payer: UMR Bronson Commercial |
$99.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.50
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna American Axle |
$44.85
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$43.47
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$242.70 |
| Rate for Payer: Aetna American Axle |
$44.85
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$242.70
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.51
|
| Rate for Payer: Priority Health Narrow Network |
$62.81
|
| Rate for Payer: Priority Health SBD |
$43.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.20
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$464.57 |
| Max. Negotiated Rate |
$950.25 |
| Rate for Payer: Aetna American Axle |
$686.29
|
| Rate for Payer: Aetna Commercial |
$897.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.29
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$739.08
|
| Rate for Payer: Cofinity Commercial |
$908.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Healthscope Commercial |
$950.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: PHP Commercial |
$897.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: Priority Health SBD |
$665.17
|
| Rate for Payer: UMR Bronson Commercial |
$464.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.87
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,055.83
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$390.66 |
| Max. Negotiated Rate |
$1,655.53 |
| Rate for Payer: Aetna American Axle |
$686.29
|
| Rate for Payer: Aetna Commercial |
$897.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.29
|
| Rate for Payer: BCBS Complete |
$422.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.53
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cash Price |
$844.66
|
| Rate for Payer: Cofinity Commercial |
$739.08
|
| Rate for Payer: Cofinity Commercial |
$908.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.66
|
| Rate for Payer: Healthscope Commercial |
$950.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$897.46
|
| Rate for Payer: PHP Commercial |
$897.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.54
|
| Rate for Payer: Priority Health Narrow Network |
$428.43
|
| Rate for Payer: Priority Health SBD |
$665.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.42
|
| Rate for Payer: UHC Exchange |
$637.85
|
| Rate for Payer: UMR Bronson Commercial |
$390.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.87
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.45 |
| Max. Negotiated Rate |
$2,477.22 |
| Rate for Payer: Aetna American Axle |
$445.25
|
| Rate for Payer: Aetna Commercial |
$582.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.25
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,477.22
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$589.10
|
| Rate for Payer: Cofinity Commercial |
$479.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Healthscope Commercial |
$616.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: PHP Commercial |
$582.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$801.35
|
| Rate for Payer: Priority Health Narrow Network |
$641.08
|
| Rate for Payer: Priority Health SBD |
$431.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.78
|
| Rate for Payer: UHC Exchange |
$938.98
|
| Rate for Payer: UMR Bronson Commercial |
$253.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.75
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$301.40 |
| Max. Negotiated Rate |
$616.50 |
| Rate for Payer: Aetna American Axle |
$445.25
|
| Rate for Payer: Aetna Commercial |
$582.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.25
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$589.10
|
| Rate for Payer: Cofinity Commercial |
$479.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.00
|
| Rate for Payer: Healthscope Commercial |
$616.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$582.25
|
| Rate for Payer: PHP Commercial |
$582.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health SBD |
$431.55
|
| Rate for Payer: UMR Bronson Commercial |
$301.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.75
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$67.37 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.37
|
| Rate for Payer: Priority Health Narrow Network |
$53.90
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$706.31 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Trust/PPO |
$706.31
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.48
|
| Rate for Payer: Priority Health Narrow Network |
$182.78
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.54
|
| Rate for Payer: UHC Exchange |
$272.12
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$86.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$414.37
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$372.93 |
| Rate for Payer: Aetna American Axle |
$269.34
|
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.21
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.06
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: UMR Bronson Commercial |
$182.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
|
