|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$527.34
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.03 |
| Max. Negotiated Rate |
$474.61 |
| 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: 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 SBD |
$332.22
|
| Rate for Payer: UMR Bronson Commercial |
$232.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.50
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna American Axle |
$37.73
|
| Rate for Payer: Aetna Commercial |
$49.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.73
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Cofinity Commercial |
$49.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: PHP Commercial |
$49.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: Priority Health SBD |
$36.57
|
| Rate for Payer: UMR Bronson Commercial |
$25.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.53
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$58.04
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna American Axle |
$37.73
|
| Rate for Payer: Aetna Commercial |
$49.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.73
|
| Rate for Payer: BCBS Complete |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$96.20
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Cofinity Commercial |
$49.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.43
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.33
|
| Rate for Payer: PHP Commercial |
$49.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.12
|
| Rate for Payer: Priority Health Narrow Network |
$24.90
|
| Rate for Payer: Priority Health SBD |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.72
|
| Rate for Payer: UHC Exchange |
$38.93
|
| Rate for Payer: UMR Bronson Commercial |
$21.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.53
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.17 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna American Axle |
$201.16
|
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.16
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$216.63
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| Rate for Payer: Priority Health SBD |
$194.97
|
| Rate for Payer: UMR Bronson Commercial |
$136.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$309.47
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna American Axle |
$201.16
|
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.16
|
| Rate for Payer: BCBS Complete |
$123.79
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$216.63
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.05
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.63
|
| 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 |
$194.97
|
| Rate for Payer: UMR Bronson Commercial |
$114.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.77 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna American Axle |
$100.11
|
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health SBD |
$97.03
|
| Rate for Payer: UMR Bronson Commercial |
$67.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$241.49 |
| Rate for Payer: Aetna American Axle |
$100.11
|
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| Rate for Payer: BCBS Complete |
$61.61
|
| Rate for Payer: BCBS Trust/PPO |
$241.49
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.92
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.12
|
| Rate for Payer: Priority Health Narrow Network |
$62.50
|
| Rate for Payer: Priority Health SBD |
$97.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.99
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna American Axle |
$70.43
|
| Rate for Payer: Aetna Commercial |
$92.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.43
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$97.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: PHP Commercial |
$92.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$68.27
|
| Rate for Payer: UMR Bronson Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.27
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$108.36
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.09 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna American Axle |
$70.43
|
| Rate for Payer: Aetna Commercial |
$92.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.43
|
| Rate for Payer: BCBS Complete |
$43.34
|
| Rate for Payer: BCBS Trust/PPO |
$169.88
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cofinity Commercial |
$93.19
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.69
|
| Rate for Payer: Healthscope Commercial |
$97.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.11
|
| Rate for Payer: PHP Commercial |
$92.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.95
|
| Rate for Payer: Priority Health Narrow Network |
$43.96
|
| Rate for Payer: Priority Health SBD |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.42
|
| Rate for Payer: UHC Exchange |
$65.35
|
| Rate for Payer: UMR Bronson Commercial |
$40.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.27
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$242.70 |
| Rate for Payer: Aetna American Axle |
$62.72
|
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.72
|
| Rate for Payer: BCBS Complete |
$38.60
|
| Rate for Payer: BCBS Trust/PPO |
$242.70
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$82.98
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$86.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: PHP Commercial |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| 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 |
$60.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.20
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UMR Bronson Commercial |
$35.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.37
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$96.49
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$86.84 |
| Rate for Payer: Aetna American Axle |
$62.72
|
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.72
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$82.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$86.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: PHP Commercial |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.54
|
| Rate for Payer: Priority Health SBD |
$60.79
|
| Rate for Payer: UMR Bronson Commercial |
$42.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.37
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,184.00 |
| Max. Negotiated Rate |
$7,443.00 |
| Rate for Payer: Aetna American Axle |
$2,080.00
|
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,080.00
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,443.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Cofinity Commercial |
$2,240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,240.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,407.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,926.16
|
| Rate for Payer: Priority Health SBD |
$2,016.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,318.94
|
| Rate for Payer: UHC Exchange |
$2,765.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,184.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,408.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna American Axle |
$2,080.00
|
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,240.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,240.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health SBD |
$2,016.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,408.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,301.31 |
| Max. Negotiated Rate |
$2,661.78 |
| Rate for Payer: Aetna American Axle |
$1,922.39
|
| Rate for Payer: Aetna Commercial |
$2,513.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,922.39
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,543.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Healthscope Commercial |
$2,661.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,070.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: PHP Commercial |
$2,513.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: Priority Health SBD |
$1,863.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,301.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,218.15
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,094.29 |
| Max. Negotiated Rate |
$5,406.70 |
| Rate for Payer: Aetna American Axle |
$1,922.39
|
| Rate for Payer: Aetna Commercial |
$2,513.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,922.39
|
| Rate for Payer: BCBS Complete |
$1,183.01
|
| Rate for Payer: BCBS Trust/PPO |
$5,406.70
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,543.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Healthscope Commercial |
$2,661.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,070.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: PHP Commercial |
$2,513.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,748.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,399.19
|
| Rate for Payer: Priority Health SBD |
$1,863.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,499.83
|
| Rate for Payer: UHC Exchange |
$2,083.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,218.15
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.77 |
| Max. Negotiated Rate |
$3,651.29 |
| Rate for Payer: Aetna American Axle |
$1,276.76
|
| Rate for Payer: Aetna Commercial |
$1,669.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.76
|
| Rate for Payer: BCBS Complete |
$785.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,651.29
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,374.98
|
| Rate for Payer: Cofinity Commercial |
$1,689.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Healthscope Commercial |
$1,767.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: PHP Commercial |
$1,669.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.14
|
| Rate for Payer: Priority Health Narrow Network |
$944.91
|
| Rate for Payer: Priority Health SBD |
$1,237.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,688.22
|
| Rate for Payer: UHC Exchange |
$1,406.85
|
| Rate for Payer: UMR Bronson Commercial |
$726.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.19
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$864.27 |
| Max. Negotiated Rate |
$1,767.82 |
| Rate for Payer: Aetna American Axle |
$1,276.76
|
| Rate for Payer: Aetna Commercial |
$1,669.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.76
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,374.98
|
| Rate for Payer: Cofinity Commercial |
$1,689.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Healthscope Commercial |
$1,767.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: PHP Commercial |
$1,669.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: Priority Health SBD |
$1,237.48
|
| Rate for Payer: UMR Bronson Commercial |
$864.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.19
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$1,300.33 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.33
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.64
|
| Rate for Payer: Priority Health Narrow Network |
$336.51
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$643.04
|
| Rate for Payer: UHC Exchange |
$535.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna American Axle |
$23.04
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.04
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$24.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$31.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| Rate for Payer: Priority Health SBD |
$22.33
|
| Rate for Payer: UMR Bronson Commercial |
$15.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.58
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$242.70 |
| Rate for Payer: Aetna American Axle |
$23.04
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.04
|
| Rate for Payer: BCBS Complete |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$242.70
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$24.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$31.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| 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 |
$22.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.20
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.58
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$130.17 |
| Rate for Payer: Aetna American Axle |
$94.01
|
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.01
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$101.24
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health SBD |
$91.12
|
| Rate for Payer: UMR Bronson Commercial |
$63.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.47
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$222.78 |
| Rate for Payer: Aetna American Axle |
$94.01
|
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.01
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.78
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$101.24
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.07
|
| Rate for Payer: Priority Health Narrow Network |
$57.66
|
| Rate for Payer: Priority Health SBD |
$91.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.56
|
| Rate for Payer: UHC Exchange |
$95.47
|
| Rate for Payer: UMR Bronson Commercial |
$53.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.47
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.31 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna American Axle |
$216.14
|
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.14
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$232.76
|
| Rate for Payer: Cofinity Commercial |
$285.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: PHP Commercial |
$282.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: Priority Health SBD |
$209.49
|
| Rate for Payer: UMR Bronson Commercial |
$146.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.39
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.03 |
| Max. Negotiated Rate |
$1,179.21 |
| Rate for Payer: Aetna American Axle |
$216.14
|
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.14
|
| Rate for Payer: BCBS Complete |
$133.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.21
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$232.76
|
| Rate for Payer: Cofinity Commercial |
$285.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: PHP Commercial |
$282.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.46
|
| Rate for Payer: Priority Health Narrow Network |
$305.17
|
| Rate for Payer: Priority Health SBD |
$209.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.41
|
| Rate for Payer: UHC Exchange |
$475.34
|
| Rate for Payer: UMR Bronson Commercial |
$123.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.39
|
|
