|
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
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$576.71 |
| Rate for Payer: Aetna American Axle |
$323.21
|
| Rate for Payer: Aetna Commercial |
$422.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.21
|
| Rate for Payer: BCBS Complete |
$198.90
|
| Rate for Payer: BCBS Trust/PPO |
$576.71
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Cofinity Commercial |
$427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Healthscope Commercial |
$447.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: PHP Commercial |
$422.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.56
|
| Rate for Payer: Priority Health Narrow Network |
$149.25
|
| Rate for Payer: Priority Health SBD |
$313.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.63
|
| Rate for Payer: UHC Exchange |
$222.19
|
| Rate for Payer: UMR Bronson Commercial |
$183.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.93
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$497.24
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$447.52 |
| Rate for Payer: Aetna American Axle |
$323.21
|
| Rate for Payer: Aetna Commercial |
$422.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.21
|
| Rate for Payer: Cash Price |
$397.79
|
| Rate for Payer: Cofinity Commercial |
$348.07
|
| Rate for Payer: Cofinity Commercial |
$427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.79
|
| Rate for Payer: Healthscope Commercial |
$447.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.65
|
| Rate for Payer: PHP Commercial |
$422.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health SBD |
$313.26
|
| Rate for Payer: UMR Bronson Commercial |
$218.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.93
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$1,063.34 |
| Rate for Payer: Aetna American Axle |
$191.10
|
| Rate for Payer: Aetna Commercial |
$249.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.10
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.34
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$252.84
|
| Rate for Payer: Cofinity Commercial |
$205.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Healthscope Commercial |
$264.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: PHP Commercial |
$249.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.98
|
| Rate for Payer: Priority Health Narrow Network |
$275.18
|
| Rate for Payer: Priority Health SBD |
$185.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.62
|
| Rate for Payer: UHC Exchange |
$409.68
|
| Rate for Payer: UMR Bronson Commercial |
$108.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.50
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna American Axle |
$191.10
|
| Rate for Payer: Aetna Commercial |
$249.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.10
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$252.84
|
| Rate for Payer: Cofinity Commercial |
$205.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.20
|
| Rate for Payer: Healthscope Commercial |
$264.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.90
|
| Rate for Payer: PHP Commercial |
$249.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health SBD |
$185.22
|
| Rate for Payer: UMR Bronson Commercial |
$129.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.50
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.44 |
| Max. Negotiated Rate |
$896.48 |
| Rate for Payer: Aetna American Axle |
$327.52
|
| Rate for Payer: Aetna Commercial |
$428.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.52
|
| Rate for Payer: BCBS Complete |
$201.55
|
| Rate for Payer: BCBS Trust/PPO |
$896.48
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$352.72
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Healthscope Commercial |
$453.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: PHP Commercial |
$428.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.00
|
| Rate for Payer: Priority Health Narrow Network |
$232.00
|
| Rate for Payer: Priority Health SBD |
$317.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.54
|
| Rate for Payer: UHC Exchange |
$345.45
|
| Rate for Payer: UMR Bronson Commercial |
$186.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.91
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$503.88
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$221.71 |
| Max. Negotiated Rate |
$453.49 |
| Rate for Payer: Aetna American Axle |
$327.52
|
| Rate for Payer: Aetna Commercial |
$428.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.52
|
| Rate for Payer: Cash Price |
$403.10
|
| Rate for Payer: Cofinity Commercial |
$352.72
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.10
|
| Rate for Payer: Healthscope Commercial |
$453.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.30
|
| Rate for Payer: PHP Commercial |
$428.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health SBD |
$317.44
|
| Rate for Payer: UMR Bronson Commercial |
$221.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.91
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.52 |
| Max. Negotiated Rate |
$371.29 |
| Rate for Payer: Aetna American Axle |
$268.15
|
| Rate for Payer: Aetna Commercial |
$350.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.15
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$288.78
|
| Rate for Payer: Cofinity Commercial |
$354.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Healthscope Commercial |
$371.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: PHP Commercial |
$350.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: Priority Health SBD |
$259.90
|
| Rate for Payer: UMR Bronson Commercial |
$181.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.40
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$412.54
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$371.29 |
| Rate for Payer: Aetna American Axle |
$268.15
|
| Rate for Payer: Aetna Commercial |
$350.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.15
|
| Rate for Payer: BCBS Complete |
$165.02
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cash Price |
$330.03
|
| Rate for Payer: Cofinity Commercial |
$354.78
|
| Rate for Payer: Cofinity Commercial |
$288.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.03
|
| Rate for Payer: Healthscope Commercial |
$371.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.66
|
| Rate for Payer: PHP Commercial |
$350.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.26
|
| Rate for Payer: Priority Health Narrow Network |
$167.41
|
| Rate for Payer: Priority Health SBD |
$259.90
|
| Rate for Payer: UMR Bronson Commercial |
$152.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.40
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$190.30 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$190.30
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UMR Bronson Commercial |
$55.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$302.36 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$302.36
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.81
|
| Rate for Payer: Priority Health Narrow Network |
$78.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.65
|
| Rate for Payer: UHC Exchange |
$112.21
|
| Rate for Payer: UMR Bronson Commercial |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna American Axle |
$164.42
|
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.07
|
| Rate for Payer: Priority Health SBD |
$159.36
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$896.48 |
| Rate for Payer: Aetna American Axle |
$164.42
|
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: BCBS Complete |
$101.18
|
| Rate for Payer: BCBS Trust/PPO |
$896.48
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.00
|
| Rate for Payer: Priority Health Narrow Network |
$232.00
|
| Rate for Payer: Priority Health SBD |
$159.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.54
|
| Rate for Payer: UHC Exchange |
$345.45
|
| Rate for Payer: UMR Bronson Commercial |
$93.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.72
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,811.44
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.03 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Aetna American Axle |
$1,177.44
|
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.44
|
| Rate for Payer: Cash Price |
$1,449.15
|
| Rate for Payer: Cofinity Commercial |
$1,268.01
|
| Rate for Payer: Cofinity Commercial |
$1,557.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.15
|
| Rate for Payer: Healthscope Commercial |
$1,630.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,268.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.72
|
| Rate for Payer: PHP Commercial |
$1,539.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.01
|
| Rate for Payer: Priority Health SBD |
$1,141.21
|
| Rate for Payer: UMR Bronson Commercial |
$797.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.58
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,811.44
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$670.23 |
| Max. Negotiated Rate |
$3,408.25 |
| Rate for Payer: Aetna American Axle |
$1,177.44
|
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.44
|
| Rate for Payer: BCBS Complete |
$724.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,408.25
|
| Rate for Payer: Cash Price |
$1,449.15
|
| Rate for Payer: Cash Price |
$1,449.15
|
| Rate for Payer: Cofinity Commercial |
$1,557.84
|
| Rate for Payer: Cofinity Commercial |
$1,268.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,449.15
|
| Rate for Payer: Healthscope Commercial |
$1,630.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,268.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.72
|
| Rate for Payer: PHP Commercial |
$1,539.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,102.52
|
| Rate for Payer: Priority Health Narrow Network |
$882.02
|
| Rate for Payer: Priority Health SBD |
$1,141.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,605.73
|
| Rate for Payer: UHC Exchange |
$1,338.11
|
| Rate for Payer: UMR Bronson Commercial |
$670.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.58
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$816.74
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$302.19 |
| Max. Negotiated Rate |
$1,280.64 |
| Rate for Payer: Aetna American Axle |
$530.88
|
| Rate for Payer: Aetna Commercial |
$694.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.88
|
| Rate for Payer: BCBS Complete |
$326.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.64
|
| Rate for Payer: Cash Price |
$653.39
|
| Rate for Payer: Cash Price |
$653.39
|
| Rate for Payer: Cofinity Commercial |
$702.40
|
| Rate for Payer: Cofinity Commercial |
$571.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.39
|
| Rate for Payer: Healthscope Commercial |
$735.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.23
|
| Rate for Payer: PHP Commercial |
$694.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.27
|
| Rate for Payer: Priority Health Narrow Network |
$331.42
|
| Rate for Payer: Priority Health SBD |
$514.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.52
|
| Rate for Payer: UHC Exchange |
$443.77
|
| Rate for Payer: UMR Bronson Commercial |
$302.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.56
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$816.74
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$359.37 |
| Max. Negotiated Rate |
$735.07 |
| Rate for Payer: Aetna American Axle |
$530.88
|
| Rate for Payer: Aetna Commercial |
$694.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.88
|
| Rate for Payer: Cash Price |
$653.39
|
| Rate for Payer: Cofinity Commercial |
$571.72
|
| Rate for Payer: Cofinity Commercial |
$702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.39
|
| Rate for Payer: Healthscope Commercial |
$735.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.23
|
| Rate for Payer: PHP Commercial |
$694.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.72
|
| Rate for Payer: Priority Health SBD |
$514.55
|
| Rate for Payer: UMR Bronson Commercial |
$359.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.56
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$939.18
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$347.50 |
| Max. Negotiated Rate |
$1,472.62 |
| Rate for Payer: Aetna American Axle |
$610.47
|
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.47
|
| Rate for Payer: BCBS Complete |
$375.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.62
|
| Rate for Payer: Cash Price |
$751.34
|
| Rate for Payer: Cash Price |
$751.34
|
| Rate for Payer: Cofinity Commercial |
$657.43
|
| Rate for Payer: Cofinity Commercial |
$807.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.34
|
| Rate for Payer: Healthscope Commercial |
$845.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$657.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.30
|
| Rate for Payer: PHP Commercial |
$798.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.37
|
| Rate for Payer: Priority Health Narrow Network |
$381.10
|
| Rate for Payer: Priority Health SBD |
$591.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.77
|
| Rate for Payer: UHC Exchange |
$593.14
|
| Rate for Payer: UMR Bronson Commercial |
$347.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.38
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$939.18
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$413.24 |
| Max. Negotiated Rate |
$845.26 |
| Rate for Payer: Aetna American Axle |
$610.47
|
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.47
|
| Rate for Payer: Cash Price |
$751.34
|
| Rate for Payer: Cofinity Commercial |
$657.43
|
| Rate for Payer: Cofinity Commercial |
$807.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.34
|
| Rate for Payer: Healthscope Commercial |
$845.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$657.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.30
|
| Rate for Payer: PHP Commercial |
$798.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health SBD |
$591.68
|
| Rate for Payer: UMR Bronson Commercial |
$413.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.38
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,873.55
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,144.36 |
| Max. Negotiated Rate |
$4,386.20 |
| Rate for Payer: Aetna American Axle |
$3,167.81
|
| Rate for Payer: Aetna Commercial |
$4,142.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,167.81
|
| Rate for Payer: Cash Price |
$3,898.84
|
| Rate for Payer: Cofinity Commercial |
$3,411.48
|
| Rate for Payer: Cofinity Commercial |
$4,191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,898.84
|
| Rate for Payer: Healthscope Commercial |
$4,386.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,411.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,655.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,142.52
|
| Rate for Payer: PHP Commercial |
$4,142.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.48
|
| Rate for Payer: Priority Health SBD |
$3,070.34
|
| Rate for Payer: UMR Bronson Commercial |
$2,144.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,655.16
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,873.55
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,803.21 |
| Max. Negotiated Rate |
$4,386.20 |
| Rate for Payer: Aetna American Axle |
$3,167.81
|
| Rate for Payer: Aetna Commercial |
$4,142.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,167.81
|
| Rate for Payer: BCBS Complete |
$1,949.42
|
| Rate for Payer: Cash Price |
$3,898.84
|
| Rate for Payer: Cofinity Commercial |
$3,411.48
|
| Rate for Payer: Cofinity Commercial |
$4,191.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,898.84
|
| Rate for Payer: Healthscope Commercial |
$4,386.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,411.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,655.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,142.52
|
| Rate for Payer: PHP Commercial |
$4,142.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.48
|
| Rate for Payer: Priority Health SBD |
$3,070.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,803.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,655.16
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,358.21
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$597.61 |
| Max. Negotiated Rate |
$1,222.39 |
| Rate for Payer: Aetna American Axle |
$882.84
|
| Rate for Payer: Aetna Commercial |
$1,154.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.84
|
| Rate for Payer: Cash Price |
$1,086.57
|
| Rate for Payer: Cofinity Commercial |
$1,168.06
|
| Rate for Payer: Cofinity Commercial |
$950.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.57
|
| Rate for Payer: Healthscope Commercial |
$1,222.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$950.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,154.48
|
| Rate for Payer: PHP Commercial |
$1,154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.75
|
| Rate for Payer: Priority Health SBD |
$855.67
|
| Rate for Payer: UMR Bronson Commercial |
$597.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.66
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,358.21
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.54 |
| Max. Negotiated Rate |
$2,505.39 |
| Rate for Payer: Aetna American Axle |
$882.84
|
| Rate for Payer: Aetna Commercial |
$1,154.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.84
|
| Rate for Payer: BCBS Complete |
$543.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,505.39
|
| Rate for Payer: Cash Price |
$1,086.57
|
| Rate for Payer: Cash Price |
$1,086.57
|
| Rate for Payer: Cofinity Commercial |
$950.75
|
| Rate for Payer: Cofinity Commercial |
$1,168.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.57
|
| Rate for Payer: Healthscope Commercial |
$1,222.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$950.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,154.48
|
| Rate for Payer: PHP Commercial |
$1,154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$810.46
|
| Rate for Payer: Priority Health Narrow Network |
$648.37
|
| Rate for Payer: Priority Health SBD |
$855.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,070.20
|
| Rate for Payer: UHC Exchange |
$891.83
|
| Rate for Payer: UMR Bronson Commercial |
$502.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.66
|
|
