|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,597.90
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$385.42 |
| Max. Negotiated Rate |
$1,772.41 |
| Rate for Payer: Aetna American Axle |
$1,038.64
|
| Rate for Payer: Aetna Commercial |
$1,358.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.64
|
| Rate for Payer: BCBS Complete |
$639.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,772.41
|
| Rate for Payer: Cash Price |
$1,278.32
|
| Rate for Payer: Cash Price |
$1,278.32
|
| Rate for Payer: Cofinity Commercial |
$1,374.19
|
| Rate for Payer: Cofinity Commercial |
$1,118.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,278.32
|
| Rate for Payer: Healthscope Commercial |
$1,438.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,118.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,198.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,358.22
|
| Rate for Payer: PHP Commercial |
$1,358.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.78
|
| Rate for Payer: Priority Health Narrow Network |
$385.42
|
| Rate for Payer: Priority Health SBD |
$1,006.68
|
| Rate for Payer: UMR Bronson Commercial |
$591.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,198.42
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,597.90
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$1,438.11 |
| Rate for Payer: Aetna American Axle |
$1,038.64
|
| Rate for Payer: Aetna Commercial |
$1,358.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.64
|
| Rate for Payer: Cash Price |
$1,278.32
|
| Rate for Payer: Cofinity Commercial |
$1,118.53
|
| Rate for Payer: Cofinity Commercial |
$1,374.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,278.32
|
| Rate for Payer: Healthscope Commercial |
$1,438.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,118.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,198.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,358.22
|
| Rate for Payer: PHP Commercial |
$1,358.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.53
|
| Rate for Payer: Priority Health SBD |
$1,006.68
|
| Rate for Payer: UMR Bronson Commercial |
$703.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,198.42
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$198.85
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$178.96 |
| Rate for Payer: Aetna American Axle |
$129.25
|
| Rate for Payer: Aetna Commercial |
$169.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.25
|
| Rate for Payer: Cash Price |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$171.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.08
|
| Rate for Payer: Healthscope Commercial |
$178.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.02
|
| Rate for Payer: PHP Commercial |
$169.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.20
|
| Rate for Payer: Priority Health SBD |
$125.28
|
| Rate for Payer: UMR Bronson Commercial |
$87.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.14
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$198.85
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: Aetna American Axle |
$129.25
|
| Rate for Payer: Aetna Commercial |
$169.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.25
|
| Rate for Payer: BCBS Complete |
$79.54
|
| Rate for Payer: BCBS Trust/PPO |
$234.74
|
| Rate for Payer: Cash Price |
$159.08
|
| Rate for Payer: Cash Price |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$171.01
|
| Rate for Payer: Cofinity Commercial |
$139.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.08
|
| Rate for Payer: Healthscope Commercial |
$178.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.02
|
| Rate for Payer: PHP Commercial |
$169.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.88
|
| Rate for Payer: Priority Health Narrow Network |
$53.50
|
| Rate for Payer: Priority Health SBD |
$125.28
|
| Rate for Payer: UMR Bronson Commercial |
$73.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.14
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$236.43 |
| Max. Negotiated Rate |
$1,495.01 |
| Rate for Payer: Aetna American Axle |
$415.35
|
| Rate for Payer: Aetna Commercial |
$543.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.35
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.01
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$549.54
|
| Rate for Payer: Cofinity Commercial |
$447.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.20
|
| Rate for Payer: Healthscope Commercial |
$575.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$447.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$543.15
|
| Rate for Payer: PHP Commercial |
$543.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.62
|
| Rate for Payer: Priority Health Narrow Network |
$386.90
|
| Rate for Payer: Priority Health SBD |
$402.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.49
|
| Rate for Payer: UHC Exchange |
$576.24
|
| Rate for Payer: UMR Bronson Commercial |
$236.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$479.25
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$575.10 |
| Rate for Payer: Aetna American Axle |
$415.35
|
| Rate for Payer: Aetna Commercial |
$543.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.35
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$447.30
|
| Rate for Payer: Cofinity Commercial |
$549.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.20
|
| Rate for Payer: Healthscope Commercial |
$575.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$447.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$543.15
|
| Rate for Payer: PHP Commercial |
$543.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.30
|
| Rate for Payer: Priority Health SBD |
$402.57
|
| Rate for Payer: UMR Bronson Commercial |
$281.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$479.25
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$283.52 |
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS Trust/PPO |
$283.52
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.71
|
| Rate for Payer: Priority Health Narrow Network |
$73.37
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.11
|
| Rate for Payer: UHC Exchange |
$109.26
|
| Rate for Payer: UMR Bronson Commercial |
$67.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: UMR Bronson Commercial |
$80.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$191.10
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Aetna American Axle |
$124.22
|
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.22
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Commercial |
$133.77
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.44
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.77
|
| Rate for Payer: Priority Health SBD |
$120.39
|
| Rate for Payer: UMR Bronson Commercial |
$84.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$191.10
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$186.46 |
| Rate for Payer: Aetna American Axle |
$124.22
|
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.22
|
| Rate for Payer: BCBS Complete |
$76.44
|
| Rate for Payer: BCBS Trust/PPO |
$186.46
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Cofinity Commercial |
$133.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.44
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.59
|
| Rate for Payer: Priority Health Narrow Network |
$38.87
|
| Rate for Payer: Priority Health SBD |
$120.39
|
| Rate for Payer: UMR Bronson Commercial |
$70.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,504.42
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.94 |
| Max. Negotiated Rate |
$2,253.98 |
| Rate for Payer: Aetna American Axle |
$1,627.87
|
| Rate for Payer: Aetna Commercial |
$2,128.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,627.87
|
| Rate for Payer: Cash Price |
$2,003.54
|
| Rate for Payer: Cofinity Commercial |
$1,753.09
|
| Rate for Payer: Cofinity Commercial |
$2,153.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,003.54
|
| Rate for Payer: Healthscope Commercial |
$2,253.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,753.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,878.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,128.76
|
| Rate for Payer: PHP Commercial |
$2,128.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.09
|
| Rate for Payer: Priority Health SBD |
$1,577.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,878.32
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,504.42
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$2,253.98 |
| Rate for Payer: Aetna American Axle |
$1,627.87
|
| Rate for Payer: Aetna Commercial |
$2,128.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,627.87
|
| Rate for Payer: BCBS Complete |
$1,001.77
|
| Rate for Payer: Cash Price |
$2,003.54
|
| Rate for Payer: Cofinity Commercial |
$1,753.09
|
| Rate for Payer: Cofinity Commercial |
$2,153.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,003.54
|
| Rate for Payer: Healthscope Commercial |
$2,253.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,753.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,878.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,128.76
|
| Rate for Payer: PHP Commercial |
$2,128.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.09
|
| Rate for Payer: Priority Health SBD |
$1,577.78
|
| Rate for Payer: UMR Bronson Commercial |
$926.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,878.32
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,665.96
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,173.02 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna American Axle |
$1,732.87
|
| Rate for Payer: Aetna Commercial |
$2,266.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.87
|
| Rate for Payer: Cash Price |
$2,132.77
|
| Rate for Payer: Cofinity Commercial |
$1,866.17
|
| Rate for Payer: Cofinity Commercial |
$2,292.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.77
|
| Rate for Payer: Healthscope Commercial |
$2,399.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,266.07
|
| Rate for Payer: PHP Commercial |
$2,266.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.17
|
| Rate for Payer: Priority Health SBD |
$1,679.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.47
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,665.96
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$986.41 |
| Max. Negotiated Rate |
$4,712.19 |
| Rate for Payer: Aetna American Axle |
$1,732.87
|
| Rate for Payer: Aetna Commercial |
$2,266.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.87
|
| Rate for Payer: BCBS Complete |
$1,066.38
|
| Rate for Payer: BCBS Trust/PPO |
$4,712.19
|
| Rate for Payer: Cash Price |
$2,132.77
|
| Rate for Payer: Cash Price |
$2,132.77
|
| Rate for Payer: Cofinity Commercial |
$2,292.73
|
| Rate for Payer: Cofinity Commercial |
$1,866.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.77
|
| Rate for Payer: Healthscope Commercial |
$2,399.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,266.07
|
| Rate for Payer: PHP Commercial |
$2,266.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,524.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,219.46
|
| Rate for Payer: Priority Health SBD |
$1,679.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,973.95
|
| Rate for Payer: UHC Exchange |
$1,644.96
|
| Rate for Payer: UMR Bronson Commercial |
$986.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.47
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$364.52
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna American Axle |
$236.94
|
| Rate for Payer: Aetna Commercial |
$309.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$255.16
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.84
|
| Rate for Payer: PHP Commercial |
$309.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.16
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: UMR Bronson Commercial |
$160.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.39
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$364.52
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.87 |
| Max. Negotiated Rate |
$571.51 |
| Rate for Payer: Aetna American Axle |
$236.94
|
| Rate for Payer: Aetna Commercial |
$309.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: BCBS Trust/PPO |
$571.51
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$255.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.84
|
| Rate for Payer: PHP Commercial |
$309.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.87
|
| Rate for Payer: Priority Health Narrow Network |
$147.90
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.85
|
| Rate for Payer: UHC Exchange |
$196.54
|
| Rate for Payer: UMR Bronson Commercial |
$134.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.39
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.29 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna American Axle |
$253.04
|
| Rate for Payer: Aetna Commercial |
$330.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.04
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$334.80
|
| Rate for Payer: Cofinity Commercial |
$272.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: PHP Commercial |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: Priority Health SBD |
$245.26
|
| Rate for Payer: UMR Bronson Commercial |
$171.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.98
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$389.30
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna American Axle |
$253.04
|
| Rate for Payer: Aetna Commercial |
$330.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.04
|
| Rate for Payer: BCBS Complete |
$155.72
|
| Rate for Payer: BCBS Trust/PPO |
$610.39
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Cofinity Commercial |
$334.80
|
| Rate for Payer: Cofinity Commercial |
$272.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.44
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.90
|
| Rate for Payer: PHP Commercial |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.45
|
| Rate for Payer: Priority Health Narrow Network |
$157.96
|
| Rate for Payer: Priority Health SBD |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.72
|
| Rate for Payer: UHC Exchange |
$234.77
|
| Rate for Payer: UMR Bronson Commercial |
$144.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.98
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.42 |
| Max. Negotiated Rate |
$385.41 |
| Rate for Payer: Aetna American Axle |
$278.35
|
| Rate for Payer: Aetna Commercial |
$364.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.35
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$299.76
|
| Rate for Payer: Cofinity Commercial |
$368.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Healthscope Commercial |
$385.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: PHP Commercial |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: Priority Health SBD |
$269.78
|
| Rate for Payer: UMR Bronson Commercial |
$188.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.17
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$428.23
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.96 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna American Axle |
$278.35
|
| Rate for Payer: Aetna Commercial |
$364.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.35
|
| Rate for Payer: BCBS Complete |
$171.29
|
| Rate for Payer: BCBS Trust/PPO |
$610.39
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cash Price |
$342.58
|
| Rate for Payer: Cofinity Commercial |
$299.76
|
| Rate for Payer: Cofinity Commercial |
$368.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.58
|
| Rate for Payer: Healthscope Commercial |
$385.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.00
|
| Rate for Payer: PHP Commercial |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.45
|
| Rate for Payer: Priority Health Narrow Network |
$157.96
|
| Rate for Payer: Priority Health SBD |
$269.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.72
|
| Rate for Payer: UHC Exchange |
$234.77
|
| Rate for Payer: UMR Bronson Commercial |
$158.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.17
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$827.72 |
| Rate for Payer: Aetna American Axle |
$343.13
|
| Rate for Payer: Aetna Commercial |
$448.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.13
|
| Rate for Payer: BCBS Complete |
$211.16
|
| Rate for Payer: BCBS Trust/PPO |
$827.72
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$369.52
|
| Rate for Payer: Cofinity Commercial |
$453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Healthscope Commercial |
$475.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: PHP Commercial |
$448.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.76
|
| Rate for Payer: Priority Health Narrow Network |
$214.21
|
| Rate for Payer: Priority Health SBD |
$332.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.72
|
| Rate for Payer: UHC Exchange |
$318.93
|
| Rate for Payer: UMR Bronson Commercial |
$195.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.92
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$527.89
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.27 |
| Max. Negotiated Rate |
$475.10 |
| Rate for Payer: Aetna American Axle |
$343.13
|
| Rate for Payer: Aetna Commercial |
$448.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.13
|
| Rate for Payer: Cash Price |
$422.31
|
| Rate for Payer: Cofinity Commercial |
$369.52
|
| Rate for Payer: Cofinity Commercial |
$453.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.31
|
| Rate for Payer: Healthscope Commercial |
$475.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.71
|
| Rate for Payer: PHP Commercial |
$448.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.52
|
| Rate for Payer: Priority Health SBD |
$332.57
|
| Rate for Payer: UMR Bronson Commercial |
$232.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.92
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$217.74 |
| Rate for Payer: Aetna American Axle |
$117.93
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.93
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS Trust/PPO |
$217.74
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Cofinity Commercial |
$127.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.43
|
| Rate for Payer: Priority Health Narrow Network |
$56.34
|
| Rate for Payer: Priority Health SBD |
$114.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.69
|
| Rate for Payer: UHC Exchange |
$93.91
|
| Rate for Payer: UMR Bronson Commercial |
$67.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.07
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$181.43
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$163.29 |
| Rate for Payer: Aetna American Axle |
$117.93
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.93
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cofinity Commercial |
$127.00
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.22
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.00
|
| Rate for Payer: Priority Health SBD |
$114.30
|
| Rate for Payer: UMR Bronson Commercial |
$79.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.07
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$2,386.96 |
| Rate for Payer: Aetna American Axle |
$342.77
|
| Rate for Payer: Aetna Commercial |
$448.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.77
|
| Rate for Payer: BCBS Complete |
$210.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,386.96
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cash Price |
$421.87
|
| Rate for Payer: Cofinity Commercial |
$369.14
|
| Rate for Payer: Cofinity Commercial |
$453.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.87
|
| Rate for Payer: Healthscope Commercial |
$474.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.24
|
| Rate for Payer: PHP Commercial |
$448.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.15
|
| Rate for Payer: Priority Health Narrow Network |
$617.72
|
| Rate for Payer: Priority Health SBD |
$332.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.26
|
| Rate for Payer: UHC Exchange |
$870.22
|
| Rate for Payer: UMR Bronson Commercial |
$195.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.50
|
|
