|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.59 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna American Axle |
$198.82
|
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.82
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Advantage |
$214.12
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: Priority Health SBD |
$192.70
|
| Rate for Payer: UMR Bronson Commercial |
$134.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.41
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$305.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$931.78 |
| Rate for Payer: Aetna American Axle |
$198.82
|
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: Aetna Medicare |
$152.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.82
|
| Rate for Payer: BCBS Complete |
$122.35
|
| Rate for Payer: BCBS Trust/PPO |
$931.78
|
| Rate for Payer: BCN Commercial |
$931.78
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Advantage |
$214.12
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.41
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$359.28
|
| Rate for Payer: Priority Health SBD |
$192.70
|
| Rate for Payer: Priority Health Tiered Network |
$287.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.82
|
| Rate for Payer: UHC Core |
$159.36
|
| Rate for Payer: UHC Exchange |
$120.21
|
| Rate for Payer: UMR Bronson Commercial |
$113.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.41
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.67 |
| Max. Negotiated Rate |
$471.82 |
| Rate for Payer: Aetna American Axle |
$340.76
|
| Rate for Payer: Aetna Commercial |
$445.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.76
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Advantage |
$366.97
|
| Rate for Payer: Cofinity Commercial |
$450.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Healthscope Commercial |
$471.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: PHP Commercial |
$445.60
|
| Rate for Payer: Priority Health SBD |
$330.27
|
| Rate for Payer: UMR Bronson Commercial |
$230.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.18
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$524.24
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.97 |
| Max. Negotiated Rate |
$785.55 |
| Rate for Payer: Aetna American Axle |
$340.76
|
| Rate for Payer: Aetna Commercial |
$445.60
|
| Rate for Payer: Aetna Medicare |
$262.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.76
|
| Rate for Payer: BCBS Complete |
$209.70
|
| Rate for Payer: BCBS Trust/PPO |
$785.55
|
| Rate for Payer: BCN Commercial |
$785.55
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cash Price |
$419.39
|
| Rate for Payer: Cofinity Advantage |
$366.97
|
| Rate for Payer: Cofinity Commercial |
$450.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.39
|
| Rate for Payer: Healthscope Commercial |
$471.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.18
|
| Rate for Payer: PHP Commercial |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.90
|
| Rate for Payer: Priority Health SBD |
$330.27
|
| Rate for Payer: Priority Health Tiered Network |
$242.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.76
|
| Rate for Payer: UHC Core |
$273.13
|
| Rate for Payer: UHC Exchange |
$206.03
|
| Rate for Payer: UMR Bronson Commercial |
$193.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.18
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.81 |
| Max. Negotiated Rate |
$386.29 |
| Rate for Payer: Aetna American Axle |
$278.99
|
| Rate for Payer: Aetna Commercial |
$364.83
|
| Rate for Payer: Aetna Medicare |
$214.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.99
|
| Rate for Payer: BCBS Complete |
$171.68
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Advantage |
$300.45
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Healthscope Commercial |
$386.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: PHP Commercial |
$364.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.57
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: Priority Health Tiered Network |
$174.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.99
|
| Rate for Payer: UHC Core |
$223.62
|
| Rate for Payer: UHC Exchange |
$168.68
|
| Rate for Payer: UMR Bronson Commercial |
$158.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.91
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$429.21
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.85 |
| Max. Negotiated Rate |
$386.29 |
| Rate for Payer: Aetna American Axle |
$278.99
|
| Rate for Payer: Aetna Commercial |
$364.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.99
|
| Rate for Payer: Cash Price |
$343.37
|
| Rate for Payer: Cofinity Advantage |
$300.45
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.37
|
| Rate for Payer: Healthscope Commercial |
$386.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.91
|
| Rate for Payer: PHP Commercial |
$364.83
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: UMR Bronson Commercial |
$188.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.91
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna American Axle |
$121.73
|
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.09
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health SBD |
$117.98
|
| Rate for Payer: UMR Bronson Commercial |
$82.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.45
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna American Axle |
$121.73
|
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna Medicare |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: BCBS Trust/PPO |
$158.72
|
| Rate for Payer: BCN Commercial |
$158.72
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.09
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health SBD |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.73
|
| Rate for Payer: UHC Core |
$97.57
|
| Rate for Payer: UHC Exchange |
$73.60
|
| Rate for Payer: UMR Bronson Commercial |
$69.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.45
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UMR Bronson Commercial |
$57.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$264.95 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$264.95
|
| Rate for Payer: BCN Commercial |
$264.95
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$102.16
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: Priority Health Tiered Network |
$81.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
| Rate for Payer: UMR Bronson Commercial |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$785.55 |
| Rate for Payer: Aetna American Axle |
$171.07
|
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: Aetna Medicare |
$131.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: BCBS Complete |
$105.27
|
| Rate for Payer: BCBS Trust/PPO |
$785.55
|
| Rate for Payer: BCN Commercial |
$785.55
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$236.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: PHP Commercial |
$223.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.90
|
| Rate for Payer: Priority Health SBD |
$165.80
|
| Rate for Payer: Priority Health Tiered Network |
$242.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$137.12
|
| Rate for Payer: UHC Exchange |
$103.43
|
| Rate for Payer: UMR Bronson Commercial |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.38
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$263.18
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.80 |
| Max. Negotiated Rate |
$236.86 |
| Rate for Payer: Aetna American Axle |
$171.07
|
| Rate for Payer: Aetna Commercial |
$223.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: Cash Price |
$210.54
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.54
|
| Rate for Payer: Healthscope Commercial |
$236.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.38
|
| Rate for Payer: PHP Commercial |
$223.70
|
| Rate for Payer: Priority Health SBD |
$165.80
|
| Rate for Payer: UMR Bronson Commercial |
$115.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.38
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$697.31 |
| Max. Negotiated Rate |
$2,986.49 |
| Rate for Payer: Aetna American Axle |
$1,225.00
|
| Rate for Payer: Aetna Commercial |
$1,601.93
|
| Rate for Payer: Aetna Medicare |
$942.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.00
|
| Rate for Payer: BCBS Complete |
$753.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,986.49
|
| Rate for Payer: BCN Commercial |
$2,986.49
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Advantage |
$1,319.23
|
| Rate for Payer: Cofinity Commercial |
$1,620.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,696.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,507.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: PHP Commercial |
$1,601.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,151.56
|
| Rate for Payer: Priority Health SBD |
$1,187.31
|
| Rate for Payer: Priority Health Tiered Network |
$921.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,225.00
|
| Rate for Payer: UHC Core |
$981.89
|
| Rate for Payer: UHC Exchange |
$740.66
|
| Rate for Payer: UMR Bronson Commercial |
$697.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.46
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,884.62
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$829.23 |
| Max. Negotiated Rate |
$1,696.16 |
| Rate for Payer: Aetna American Axle |
$1,225.00
|
| Rate for Payer: Aetna Commercial |
$1,601.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,507.70
|
| Rate for Payer: Cofinity Advantage |
$1,319.23
|
| Rate for Payer: Cofinity Commercial |
$1,620.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,507.70
|
| Rate for Payer: Healthscope Commercial |
$1,696.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.46
|
| Rate for Payer: PHP Commercial |
$1,601.93
|
| Rate for Payer: Priority Health SBD |
$1,187.31
|
| Rate for Payer: UMR Bronson Commercial |
$829.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.46
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,122.16 |
| Rate for Payer: Aetna American Axle |
$552.32
|
| Rate for Payer: Aetna Commercial |
$722.27
|
| Rate for Payer: Aetna Medicare |
$424.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.32
|
| Rate for Payer: BCBS Complete |
$339.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.16
|
| Rate for Payer: BCN Commercial |
$1,122.16
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Advantage |
$594.81
|
| Rate for Payer: Cofinity Commercial |
$730.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$764.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$679.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: PHP Commercial |
$722.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$432.69
|
| Rate for Payer: Priority Health SBD |
$535.33
|
| Rate for Payer: Priority Health Tiered Network |
$346.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.32
|
| Rate for Payer: UHC Core |
$442.71
|
| Rate for Payer: UHC Exchange |
$333.94
|
| Rate for Payer: UMR Bronson Commercial |
$314.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.30
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$849.73
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.88 |
| Max. Negotiated Rate |
$764.76 |
| Rate for Payer: Aetna American Axle |
$552.32
|
| Rate for Payer: Aetna Commercial |
$722.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.32
|
| Rate for Payer: Cash Price |
$679.78
|
| Rate for Payer: Cofinity Advantage |
$594.81
|
| Rate for Payer: Cofinity Commercial |
$730.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$764.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.30
|
| Rate for Payer: PHP Commercial |
$722.27
|
| Rate for Payer: Priority Health SBD |
$535.33
|
| Rate for Payer: UMR Bronson Commercial |
$373.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.30
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.53 |
| Max. Negotiated Rate |
$1,290.38 |
| Rate for Payer: Aetna American Axle |
$635.13
|
| Rate for Payer: Aetna Commercial |
$830.55
|
| Rate for Payer: Aetna Medicare |
$488.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.13
|
| Rate for Payer: BCBS Complete |
$390.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.38
|
| Rate for Payer: BCN Commercial |
$1,290.38
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Advantage |
$683.98
|
| Rate for Payer: Cofinity Commercial |
$840.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$879.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: PHP Commercial |
$830.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$497.56
|
| Rate for Payer: Priority Health SBD |
$615.59
|
| Rate for Payer: Priority Health Tiered Network |
$398.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.13
|
| Rate for Payer: UHC Core |
$509.08
|
| Rate for Payer: UHC Exchange |
$384.01
|
| Rate for Payer: UMR Bronson Commercial |
$361.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.84
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$977.12
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.93 |
| Max. Negotiated Rate |
$879.41 |
| Rate for Payer: Aetna American Axle |
$635.13
|
| Rate for Payer: Aetna Commercial |
$830.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.13
|
| Rate for Payer: Cash Price |
$781.70
|
| Rate for Payer: Cofinity Advantage |
$683.98
|
| Rate for Payer: Cofinity Commercial |
$840.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.70
|
| Rate for Payer: Healthscope Commercial |
$879.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.84
|
| Rate for Payer: PHP Commercial |
$830.55
|
| Rate for Payer: Priority Health SBD |
$615.59
|
| Rate for Payer: UMR Bronson Commercial |
$429.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.84
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,876.06 |
| Max. Negotiated Rate |
$4,563.40 |
| Rate for Payer: Aetna American Axle |
$3,295.79
|
| Rate for Payer: Aetna Commercial |
$4,309.87
|
| Rate for Payer: Aetna Medicare |
$2,535.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,295.79
|
| Rate for Payer: BCBS Complete |
$2,028.18
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Advantage |
$3,549.31
|
| Rate for Payer: Cofinity Commercial |
$4,360.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,563.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,549.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,802.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,056.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: PHP Commercial |
$4,309.87
|
| Rate for Payer: Priority Health SBD |
$3,194.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,295.79
|
| Rate for Payer: UHC Core |
$2,641.70
|
| Rate for Payer: UHC Exchange |
$1,992.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,876.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,802.83
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$5,070.44
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,230.99 |
| Max. Negotiated Rate |
$4,563.40 |
| Rate for Payer: Aetna American Axle |
$3,295.79
|
| Rate for Payer: Aetna Commercial |
$4,309.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,295.79
|
| Rate for Payer: Cash Price |
$4,056.35
|
| Rate for Payer: Cofinity Advantage |
$3,549.31
|
| Rate for Payer: Cofinity Commercial |
$4,360.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,056.35
|
| Rate for Payer: Healthscope Commercial |
$4,563.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,549.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,802.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.83
|
| Rate for Payer: PHP Commercial |
$4,309.87
|
| Rate for Payer: Priority Health SBD |
$3,194.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,230.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,802.83
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$621.76 |
| Max. Negotiated Rate |
$1,271.77 |
| Rate for Payer: Aetna American Axle |
$918.50
|
| Rate for Payer: Aetna Commercial |
$1,201.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.50
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Advantage |
$989.16
|
| Rate for Payer: Cofinity Commercial |
$1,215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,271.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$989.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,059.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: PHP Commercial |
$1,201.12
|
| Rate for Payer: Priority Health SBD |
$890.24
|
| Rate for Payer: UMR Bronson Commercial |
$621.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,059.81
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,413.08
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$522.84 |
| Max. Negotiated Rate |
$2,195.36 |
| Rate for Payer: Aetna American Axle |
$918.50
|
| Rate for Payer: Aetna Commercial |
$1,201.12
|
| Rate for Payer: Aetna Medicare |
$706.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.50
|
| Rate for Payer: BCBS Complete |
$565.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.36
|
| Rate for Payer: BCN Commercial |
$2,195.36
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cash Price |
$1,130.46
|
| Rate for Payer: Cofinity Advantage |
$989.16
|
| Rate for Payer: Cofinity Commercial |
$1,215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.46
|
| Rate for Payer: Healthscope Commercial |
$1,271.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$989.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,059.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,130.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,201.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,059.81
|
| Rate for Payer: PHP Commercial |
$1,201.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$846.51
|
| Rate for Payer: Priority Health SBD |
$890.24
|
| Rate for Payer: Priority Health Tiered Network |
$677.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.50
|
| Rate for Payer: UHC Core |
$736.21
|
| Rate for Payer: UHC Exchange |
$555.34
|
| Rate for Payer: UMR Bronson Commercial |
$522.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,059.81
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,662.46
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$407.70 |
| Max. Negotiated Rate |
$1,496.21 |
| Rate for Payer: Aetna American Axle |
$1,080.60
|
| Rate for Payer: Aetna Commercial |
$1,413.09
|
| Rate for Payer: Aetna Medicare |
$831.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.60
|
| Rate for Payer: BCBS Complete |
$664.98
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cofinity Advantage |
$1,163.72
|
| Rate for Payer: Cofinity Commercial |
$1,429.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,329.97
|
| Rate for Payer: Healthscope Commercial |
$1,496.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,246.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,329.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,246.85
|
| Rate for Payer: PHP Commercial |
$1,413.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$509.63
|
| Rate for Payer: Priority Health SBD |
$1,047.35
|
| Rate for Payer: Priority Health Tiered Network |
$407.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,080.60
|
| Rate for Payer: UHC Core |
$866.14
|
| Rate for Payer: UHC Exchange |
$653.35
|
| Rate for Payer: UMR Bronson Commercial |
$615.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,246.85
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,662.46
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$731.48 |
| Max. Negotiated Rate |
$1,496.21 |
| Rate for Payer: Aetna American Axle |
$1,080.60
|
| Rate for Payer: Aetna Commercial |
$1,413.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,329.97
|
| Rate for Payer: Cofinity Advantage |
$1,163.72
|
| Rate for Payer: Cofinity Commercial |
$1,429.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,329.97
|
| Rate for Payer: Healthscope Commercial |
$1,496.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,163.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,246.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,246.85
|
| Rate for Payer: PHP Commercial |
$1,413.09
|
| Rate for Payer: Priority Health SBD |
$1,047.35
|
| Rate for Payer: UMR Bronson Commercial |
$731.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,246.85
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$206.89
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.03 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna American Axle |
$134.48
|
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.48
|
| Rate for Payer: Cash Price |
$165.51
|
| Rate for Payer: Cofinity Advantage |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$177.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.51
|
| Rate for Payer: Healthscope Commercial |
$186.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.17
|
| Rate for Payer: PHP Commercial |
$175.86
|
| Rate for Payer: Priority Health SBD |
$130.34
|
| Rate for Payer: UMR Bronson Commercial |
$91.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.17
|
|
