|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,143.70
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$503.23 |
| Max. Negotiated Rate |
$1,029.33 |
| Rate for Payer: Aetna American Axle |
$743.40
|
| Rate for Payer: Aetna Commercial |
$972.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.40
|
| Rate for Payer: Cash Price |
$914.96
|
| Rate for Payer: Cofinity Advantage |
$800.59
|
| Rate for Payer: Cofinity Commercial |
$983.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.96
|
| Rate for Payer: Healthscope Commercial |
$1,029.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$800.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.77
|
| Rate for Payer: PHP Commercial |
$972.14
|
| Rate for Payer: Priority Health SBD |
$720.53
|
| Rate for Payer: UMR Bronson Commercial |
$503.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.77
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$1,695.90 |
| Rate for Payer: Aetna American Axle |
$834.73
|
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna Medicare |
$642.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.73
|
| Rate for Payer: BCBS Complete |
$513.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,695.90
|
| Rate for Payer: BCN Commercial |
$1,695.90
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Advantage |
$898.94
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$898.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$653.92
|
| Rate for Payer: Priority Health SBD |
$809.05
|
| Rate for Payer: Priority Health Tiered Network |
$523.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.73
|
| Rate for Payer: UHC Core |
$669.07
|
| Rate for Payer: UHC Exchange |
$504.69
|
| Rate for Payer: UMR Bronson Commercial |
$475.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.15
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,284.20
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,155.78 |
| Rate for Payer: Aetna American Axle |
$834.73
|
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.73
|
| Rate for Payer: Cash Price |
$1,027.36
|
| Rate for Payer: Cofinity Advantage |
$898.94
|
| Rate for Payer: Cofinity Commercial |
$1,104.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.36
|
| Rate for Payer: Healthscope Commercial |
$1,155.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$898.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$963.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$963.15
|
| Rate for Payer: PHP Commercial |
$1,091.57
|
| Rate for Payer: Priority Health SBD |
$809.05
|
| Rate for Payer: UMR Bronson Commercial |
$565.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$963.15
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$480.66 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$480.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.20 |
| Max. Negotiated Rate |
$1,254.85 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.85
|
| Rate for Payer: BCN Commercial |
$1,254.85
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.07
|
| Rate for Payer: UHC Core |
$569.15
|
| Rate for Payer: UHC Exchange |
$429.32
|
| Rate for Payer: UMR Bronson Commercial |
$404.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,220.14 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna American Axle |
$3,900.25
|
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: Aetna Medicare |
$3,000.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,900.25
|
| Rate for Payer: BCBS Complete |
$2,400.15
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Advantage |
$4,200.27
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,200.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,500.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,800.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: Priority Health SBD |
$3,780.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,900.25
|
| Rate for Payer: UHC Core |
$3,126.20
|
| Rate for Payer: UHC Exchange |
$2,358.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,220.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,500.28
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$6,000.38
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,640.17 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Aetna American Axle |
$3,900.25
|
| Rate for Payer: Aetna Commercial |
$5,100.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,900.25
|
| Rate for Payer: Cash Price |
$4,800.30
|
| Rate for Payer: Cofinity Advantage |
$4,200.27
|
| Rate for Payer: Cofinity Commercial |
$5,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,800.30
|
| Rate for Payer: Healthscope Commercial |
$5,400.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,200.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,500.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,100.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,500.28
|
| Rate for Payer: PHP Commercial |
$5,100.32
|
| Rate for Payer: Priority Health SBD |
$3,780.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,640.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,500.28
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$559.33 |
| Max. Negotiated Rate |
$1,967.10 |
| Rate for Payer: Aetna American Axle |
$982.61
|
| Rate for Payer: Aetna Commercial |
$1,284.94
|
| Rate for Payer: Aetna Medicare |
$755.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.61
|
| Rate for Payer: BCBS Complete |
$604.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,967.10
|
| Rate for Payer: BCN Commercial |
$1,967.10
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Advantage |
$1,058.19
|
| Rate for Payer: Cofinity Commercial |
$1,300.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,360.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,058.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,209.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: PHP Commercial |
$1,284.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$758.49
|
| Rate for Payer: Priority Health SBD |
$952.37
|
| Rate for Payer: Priority Health Tiered Network |
$606.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$982.61
|
| Rate for Payer: UHC Core |
$787.60
|
| Rate for Payer: UHC Exchange |
$594.10
|
| Rate for Payer: UMR Bronson Commercial |
$559.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.78
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,511.70
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$665.15 |
| Max. Negotiated Rate |
$1,360.53 |
| Rate for Payer: Aetna American Axle |
$982.61
|
| Rate for Payer: Aetna Commercial |
$1,284.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.61
|
| Rate for Payer: Cash Price |
$1,209.36
|
| Rate for Payer: Cofinity Advantage |
$1,058.19
|
| Rate for Payer: Cofinity Commercial |
$1,300.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.36
|
| Rate for Payer: Healthscope Commercial |
$1,360.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,058.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.78
|
| Rate for Payer: PHP Commercial |
$1,284.94
|
| Rate for Payer: Priority Health SBD |
$952.37
|
| Rate for Payer: UMR Bronson Commercial |
$665.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.78
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna American Axle |
$182.59
|
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.59
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Advantage |
$196.64
|
| Rate for Payer: Cofinity Commercial |
$241.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: PHP Commercial |
$238.77
|
| Rate for Payer: Priority Health SBD |
$176.97
|
| Rate for Payer: UMR Bronson Commercial |
$123.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.68
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$280.91
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$1,254.85 |
| Rate for Payer: Aetna American Axle |
$182.59
|
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: Aetna Medicare |
$140.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.59
|
| Rate for Payer: BCBS Complete |
$112.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.85
|
| Rate for Payer: BCN Commercial |
$1,254.85
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cash Price |
$224.73
|
| Rate for Payer: Cofinity Advantage |
$196.64
|
| Rate for Payer: Cofinity Commercial |
$241.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.73
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.68
|
| Rate for Payer: PHP Commercial |
$238.77
|
| Rate for Payer: Priority Health SBD |
$176.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.59
|
| Rate for Payer: UHC Core |
$146.35
|
| Rate for Payer: UHC Exchange |
$110.40
|
| Rate for Payer: UMR Bronson Commercial |
$103.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.68
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$212.66 |
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: Aetna Medicare |
$35.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: BCBS Complete |
$28.72
|
| Rate for Payer: BCBS Trust/PPO |
$212.66
|
| Rate for Payer: BCN Commercial |
$212.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$45.23
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.66
|
| Rate for Payer: UHC Core |
$37.40
|
| Rate for Payer: UHC Exchange |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$26.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna American Axle |
$46.66
|
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: Priority Health SBD |
$45.23
|
| Rate for Payer: UMR Bronson Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$988.64 |
| Rate for Payer: Aetna American Axle |
$714.02
|
| Rate for Payer: Aetna Commercial |
$933.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.02
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Advantage |
$768.94
|
| Rate for Payer: Cofinity Commercial |
$944.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Healthscope Commercial |
$988.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$768.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: PHP Commercial |
$933.72
|
| Rate for Payer: Priority Health SBD |
$692.05
|
| Rate for Payer: UMR Bronson Commercial |
$483.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.87
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,098.49
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.44 |
| Max. Negotiated Rate |
$1,450.66 |
| Rate for Payer: Aetna American Axle |
$714.02
|
| Rate for Payer: Aetna Commercial |
$933.72
|
| Rate for Payer: Aetna Medicare |
$549.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.02
|
| Rate for Payer: BCBS Complete |
$439.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.66
|
| Rate for Payer: BCN Commercial |
$1,450.66
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cash Price |
$878.79
|
| Rate for Payer: Cofinity Advantage |
$768.94
|
| Rate for Payer: Cofinity Commercial |
$944.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.79
|
| Rate for Payer: Healthscope Commercial |
$988.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$768.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$823.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$878.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.87
|
| Rate for Payer: PHP Commercial |
$933.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$559.36
|
| Rate for Payer: Priority Health SBD |
$692.05
|
| Rate for Payer: Priority Health Tiered Network |
$447.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$714.02
|
| Rate for Payer: UHC Core |
$572.31
|
| Rate for Payer: UHC Exchange |
$431.71
|
| Rate for Payer: UMR Bronson Commercial |
$406.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$823.87
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.69 |
| Max. Negotiated Rate |
$2,170.68 |
| Rate for Payer: Aetna American Axle |
$463.24
|
| Rate for Payer: Aetna Commercial |
$605.77
|
| Rate for Payer: Aetna Medicare |
$356.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.24
|
| Rate for Payer: BCBS Complete |
$285.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,170.68
|
| Rate for Payer: BCN Commercial |
$2,170.68
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Advantage |
$498.87
|
| Rate for Payer: Cofinity Commercial |
$612.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: PHP Commercial |
$605.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$836.99
|
| Rate for Payer: Priority Health SBD |
$448.98
|
| Rate for Payer: Priority Health Tiered Network |
$669.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.24
|
| Rate for Payer: UHC Core |
$371.30
|
| Rate for Payer: UHC Exchange |
$280.08
|
| Rate for Payer: UMR Bronson Commercial |
$263.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.50
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$712.67
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.57 |
| Max. Negotiated Rate |
$641.40 |
| Rate for Payer: Aetna American Axle |
$463.24
|
| Rate for Payer: Aetna Commercial |
$605.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.24
|
| Rate for Payer: Cash Price |
$570.14
|
| Rate for Payer: Cofinity Advantage |
$498.87
|
| Rate for Payer: Cofinity Commercial |
$612.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.14
|
| Rate for Payer: Healthscope Commercial |
$641.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.50
|
| Rate for Payer: PHP Commercial |
$605.77
|
| Rate for Payer: Priority Health SBD |
$448.98
|
| Rate for Payer: UMR Bronson Commercial |
$313.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.50
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC BRACE FOREFOOT RELIEF SHOE
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A9283
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$67.37 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.37
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Priority Health Tiered Network |
$53.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.05
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
IP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.72 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Aetna American Axle |
$132.55
|
| Rate for Payer: Aetna Commercial |
$173.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.55
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Advantage |
$142.74
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Healthscope Commercial |
$183.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: PHP Commercial |
$173.33
|
| Rate for Payer: Priority Health SBD |
$128.47
|
| Rate for Payer: UMR Bronson Commercial |
$89.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.94
|
|
|
HC BRACE FO W/O JOINTS CF
|
Facility
|
OP
|
$203.92
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
27400043
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$618.89 |
| Rate for Payer: Aetna American Axle |
$132.55
|
| Rate for Payer: Aetna Commercial |
$173.33
|
| Rate for Payer: Aetna Medicare |
$101.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.55
|
| Rate for Payer: BCBS Complete |
$81.57
|
| Rate for Payer: BCBS Trust/PPO |
$618.89
|
| Rate for Payer: BCN Commercial |
$618.89
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cash Price |
$163.14
|
| Rate for Payer: Cofinity Advantage |
$142.74
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.14
|
| Rate for Payer: Healthscope Commercial |
$183.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.94
|
| Rate for Payer: PHP Commercial |
$173.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$238.64
|
| Rate for Payer: Priority Health SBD |
$128.47
|
| Rate for Payer: Priority Health Tiered Network |
$190.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.55
|
| Rate for Payer: UHC Core |
$106.24
|
| Rate for Payer: UHC Exchange |
$80.14
|
| Rate for Payer: UMR Bronson Commercial |
$75.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.94
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$431.11
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna American Axle |
$280.22
|
| Rate for Payer: Aetna Commercial |
$366.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.22
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cofinity Advantage |
$301.78
|
| Rate for Payer: Cofinity Commercial |
$370.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.89
|
| Rate for Payer: Healthscope Commercial |
$388.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.33
|
| Rate for Payer: PHP Commercial |
$366.44
|
| Rate for Payer: Priority Health SBD |
$271.60
|
| Rate for Payer: UMR Bronson Commercial |
$189.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.33
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$431.11
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$505.36 |
| Rate for Payer: Aetna American Axle |
$280.22
|
| Rate for Payer: Aetna Commercial |
$366.44
|
| Rate for Payer: Aetna Medicare |
$215.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.22
|
| Rate for Payer: BCBS Complete |
$172.44
|
| Rate for Payer: BCBS Trust/PPO |
$505.36
|
| Rate for Payer: BCN Commercial |
$505.36
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cash Price |
$344.89
|
| Rate for Payer: Cofinity Advantage |
$301.78
|
| Rate for Payer: Cofinity Commercial |
$370.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.89
|
| Rate for Payer: Healthscope Commercial |
$388.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.33
|
| Rate for Payer: PHP Commercial |
$366.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$194.86
|
| Rate for Payer: Priority Health SBD |
$271.60
|
| Rate for Payer: Priority Health Tiered Network |
$155.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.22
|
| Rate for Payer: UHC Core |
$224.61
|
| Rate for Payer: UHC Exchange |
$169.43
|
| Rate for Payer: UMR Bronson Commercial |
$159.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.33
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.62 |
| Max. Negotiated Rate |
$465.59 |
| Rate for Payer: Aetna American Axle |
$336.26
|
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.26
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Advantage |
$362.12
|
| Rate for Payer: Cofinity Commercial |
$444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Healthscope Commercial |
$465.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: PHP Commercial |
$439.72
|
| Rate for Payer: Priority Health SBD |
$325.91
|
| Rate for Payer: UMR Bronson Commercial |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.99
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$517.32
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$465.59 |
| Rate for Payer: Aetna American Axle |
$336.26
|
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: Aetna Medicare |
$258.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.26
|
| Rate for Payer: BCBS Complete |
$206.93
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cash Price |
$413.86
|
| Rate for Payer: Cofinity Advantage |
$362.12
|
| Rate for Payer: Cofinity Commercial |
$444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.86
|
| Rate for Payer: Healthscope Commercial |
$465.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.99
|
| Rate for Payer: PHP Commercial |
$439.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$194.86
|
| Rate for Payer: Priority Health SBD |
$325.91
|
| Rate for Payer: Priority Health Tiered Network |
$155.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.26
|
| Rate for Payer: UHC Core |
$269.52
|
| Rate for Payer: UHC Exchange |
$203.31
|
| Rate for Payer: UMR Bronson Commercial |
$191.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.99
|
|
