|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$206.89
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna American Axle |
$134.48
|
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Medicare |
$103.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.48
|
| Rate for Payer: BCBS Complete |
$82.76
|
| Rate for Payer: BCBS Trust/PPO |
$182.23
|
| Rate for Payer: BCN Commercial |
$182.23
|
| Rate for Payer: Cash Price |
$165.51
|
| 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: MI Amish Medical Board Commercial |
$165.51
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$70.75
|
| Rate for Payer: Priority Health SBD |
$130.34
|
| Rate for Payer: Priority Health Tiered Network |
$56.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.48
|
| Rate for Payer: UHC Core |
$107.79
|
| Rate for Payer: UHC Exchange |
$81.31
|
| Rate for Payer: UMR Bronson Commercial |
$76.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.17
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$664.82
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$1,310.03 |
| Rate for Payer: Aetna American Axle |
$432.13
|
| Rate for Payer: Aetna Commercial |
$565.10
|
| Rate for Payer: Aetna Medicare |
$332.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.13
|
| Rate for Payer: BCBS Complete |
$265.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.03
|
| Rate for Payer: BCN Commercial |
$1,310.03
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cofinity Advantage |
$465.37
|
| Rate for Payer: Cofinity Commercial |
$571.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.86
|
| Rate for Payer: Healthscope Commercial |
$598.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$465.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.62
|
| Rate for Payer: PHP Commercial |
$565.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$505.13
|
| Rate for Payer: Priority Health SBD |
$418.84
|
| Rate for Payer: Priority Health Tiered Network |
$404.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.13
|
| Rate for Payer: UHC Core |
$346.37
|
| Rate for Payer: UHC Exchange |
$261.27
|
| Rate for Payer: UMR Bronson Commercial |
$245.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.62
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$664.82
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$292.52 |
| Max. Negotiated Rate |
$598.34 |
| Rate for Payer: Aetna American Axle |
$432.13
|
| Rate for Payer: Aetna Commercial |
$565.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.13
|
| Rate for Payer: Cash Price |
$531.86
|
| Rate for Payer: Cofinity Advantage |
$465.37
|
| Rate for Payer: Cofinity Commercial |
$571.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.86
|
| Rate for Payer: Healthscope Commercial |
$598.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$465.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.62
|
| Rate for Payer: PHP Commercial |
$565.10
|
| Rate for Payer: Priority Health SBD |
$418.84
|
| Rate for Payer: UMR Bronson Commercial |
$292.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.62
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$189.35
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$170.41 |
| Rate for Payer: Aetna American Axle |
$123.08
|
| Rate for Payer: Aetna Commercial |
$160.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.08
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cofinity Advantage |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$162.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.48
|
| Rate for Payer: Healthscope Commercial |
$170.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.01
|
| Rate for Payer: PHP Commercial |
$160.95
|
| Rate for Payer: Priority Health SBD |
$119.29
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.01
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$189.35
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$248.42 |
| Rate for Payer: Aetna American Axle |
$123.08
|
| Rate for Payer: Aetna Commercial |
$160.95
|
| Rate for Payer: Aetna Medicare |
$94.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.08
|
| Rate for Payer: BCBS Complete |
$75.74
|
| Rate for Payer: BCBS Trust/PPO |
$248.42
|
| Rate for Payer: BCN Commercial |
$248.42
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cofinity Advantage |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$162.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.48
|
| Rate for Payer: Healthscope Commercial |
$170.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.01
|
| Rate for Payer: PHP Commercial |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.79
|
| Rate for Payer: Priority Health SBD |
$119.29
|
| Rate for Payer: Priority Health Tiered Network |
$76.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.08
|
| Rate for Payer: UHC Core |
$98.65
|
| Rate for Payer: UHC Exchange |
$74.41
|
| Rate for Payer: UMR Bronson Commercial |
$70.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.01
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$198.82
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna American Axle |
$129.23
|
| Rate for Payer: Aetna Commercial |
$169.00
|
| Rate for Payer: Aetna Medicare |
$99.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: BCBS Complete |
$79.53
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cofinity Advantage |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.06
|
| Rate for Payer: Healthscope Commercial |
$178.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.12
|
| Rate for Payer: PHP Commercial |
$169.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.40
|
| Rate for Payer: Priority Health SBD |
$125.26
|
| Rate for Payer: Priority Health Tiered Network |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: UHC Exchange |
$78.14
|
| Rate for Payer: UMR Bronson Commercial |
$73.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.12
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$198.82
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.48 |
| Max. Negotiated Rate |
$178.94 |
| Rate for Payer: Aetna American Axle |
$129.23
|
| Rate for Payer: Aetna Commercial |
$169.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Cash Price |
$159.06
|
| Rate for Payer: Cofinity Advantage |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.06
|
| Rate for Payer: Healthscope Commercial |
$178.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.12
|
| Rate for Payer: PHP Commercial |
$169.00
|
| Rate for Payer: Priority Health SBD |
$125.26
|
| Rate for Payer: UMR Bronson Commercial |
$87.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.12
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,605.60
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$964.07 |
| Max. Negotiated Rate |
$2,345.04 |
| Rate for Payer: Aetna American Axle |
$1,693.64
|
| Rate for Payer: Aetna Commercial |
$2,214.76
|
| Rate for Payer: Aetna Medicare |
$1,302.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,693.64
|
| Rate for Payer: BCBS Complete |
$1,042.24
|
| Rate for Payer: Cash Price |
$2,084.48
|
| Rate for Payer: Cofinity Advantage |
$1,823.92
|
| Rate for Payer: Cofinity Commercial |
$2,240.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,084.48
|
| Rate for Payer: Healthscope Commercial |
$2,345.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,823.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,214.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.20
|
| Rate for Payer: PHP Commercial |
$2,214.76
|
| Rate for Payer: Priority Health SBD |
$1,641.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,693.64
|
| Rate for Payer: UHC Core |
$1,357.52
|
| Rate for Payer: UHC Exchange |
$1,024.00
|
| Rate for Payer: UMR Bronson Commercial |
$964.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.20
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,605.60
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,146.46 |
| Max. Negotiated Rate |
$2,345.04 |
| Rate for Payer: Aetna American Axle |
$1,693.64
|
| Rate for Payer: Aetna Commercial |
$2,214.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,693.64
|
| Rate for Payer: Cash Price |
$2,084.48
|
| Rate for Payer: Cofinity Advantage |
$1,823.92
|
| Rate for Payer: Cofinity Commercial |
$2,240.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,084.48
|
| Rate for Payer: Healthscope Commercial |
$2,345.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,823.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,214.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.20
|
| Rate for Payer: PHP Commercial |
$2,214.76
|
| Rate for Payer: Priority Health SBD |
$1,641.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,146.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.20
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.26 |
| Max. Negotiated Rate |
$4,129.08 |
| Rate for Payer: Aetna American Axle |
$1,802.89
|
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: Aetna Medicare |
$1,386.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,802.89
|
| Rate for Payer: BCBS Complete |
$1,109.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,129.08
|
| Rate for Payer: BCN Commercial |
$4,129.08
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Advantage |
$1,941.57
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,941.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,080.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,218.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,592.13
|
| Rate for Payer: Priority Health SBD |
$1,747.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,273.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.89
|
| Rate for Payer: UHC Core |
$1,445.08
|
| Rate for Payer: UHC Exchange |
$1,090.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,026.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,080.25
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,773.67
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,220.41 |
| Max. Negotiated Rate |
$2,496.30 |
| Rate for Payer: Aetna American Axle |
$1,802.89
|
| Rate for Payer: Aetna Commercial |
$2,357.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,802.89
|
| Rate for Payer: Cash Price |
$2,218.94
|
| Rate for Payer: Cofinity Advantage |
$1,941.57
|
| Rate for Payer: Cofinity Commercial |
$2,385.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,218.94
|
| Rate for Payer: Healthscope Commercial |
$2,496.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,941.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,080.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,357.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,080.25
|
| Rate for Payer: PHP Commercial |
$2,357.62
|
| Rate for Payer: Priority Health SBD |
$1,747.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,220.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,080.25
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$500.78 |
| Rate for Payer: Aetna American Axle |
$246.51
|
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna Medicare |
$189.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.51
|
| Rate for Payer: BCBS Complete |
$151.70
|
| Rate for Payer: BCBS Trust/PPO |
$500.78
|
| Rate for Payer: BCN Commercial |
$500.78
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Advantage |
$265.48
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193.10
|
| Rate for Payer: Priority Health SBD |
$238.93
|
| Rate for Payer: Priority Health Tiered Network |
$154.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.51
|
| Rate for Payer: UHC Core |
$197.59
|
| Rate for Payer: UHC Exchange |
$149.05
|
| Rate for Payer: UMR Bronson Commercial |
$140.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.44
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$379.25
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.87 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna American Axle |
$246.51
|
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.51
|
| Rate for Payer: Cash Price |
$303.40
|
| Rate for Payer: Cofinity Advantage |
$265.48
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.40
|
| Rate for Payer: Healthscope Commercial |
$341.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.44
|
| Rate for Payer: PHP Commercial |
$322.36
|
| Rate for Payer: Priority Health SBD |
$238.93
|
| Rate for Payer: UMR Bronson Commercial |
$166.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.44
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.86 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna American Axle |
$263.27
|
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna Medicare |
$202.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.27
|
| Rate for Payer: BCBS Complete |
$162.01
|
| Rate for Payer: BCBS Trust/PPO |
$534.85
|
| Rate for Payer: BCN Commercial |
$534.85
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Advantage |
$283.52
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.23
|
| Rate for Payer: Priority Health SBD |
$255.17
|
| Rate for Payer: Priority Health Tiered Network |
$164.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.27
|
| Rate for Payer: UHC Core |
$211.02
|
| Rate for Payer: UHC Exchange |
$159.18
|
| Rate for Payer: UMR Bronson Commercial |
$149.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.77
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$405.03
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna American Axle |
$263.27
|
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.27
|
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Cofinity Advantage |
$283.52
|
| Rate for Payer: Cofinity Commercial |
$348.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.77
|
| Rate for Payer: PHP Commercial |
$344.28
|
| Rate for Payer: Priority Health SBD |
$255.17
|
| Rate for Payer: UMR Bronson Commercial |
$178.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.77
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.03 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna American Axle |
$289.59
|
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Advantage |
$311.87
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: Priority Health SBD |
$280.68
|
| Rate for Payer: UMR Bronson Commercial |
$196.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.15
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$445.53
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.85 |
| Max. Negotiated Rate |
$400.98 |
| Rate for Payer: Aetna American Axle |
$289.59
|
| Rate for Payer: Aetna Commercial |
$378.70
|
| Rate for Payer: Aetna Medicare |
$222.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: BCBS Complete |
$178.21
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cash Price |
$356.42
|
| Rate for Payer: Cofinity Advantage |
$311.87
|
| Rate for Payer: Cofinity Commercial |
$383.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.42
|
| Rate for Payer: Healthscope Commercial |
$400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.15
|
| Rate for Payer: PHP Commercial |
$378.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.23
|
| Rate for Payer: Priority Health SBD |
$280.68
|
| Rate for Payer: Priority Health Tiered Network |
$164.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.59
|
| Rate for Payer: UHC Core |
$232.12
|
| Rate for Payer: UHC Exchange |
$175.09
|
| Rate for Payer: UMR Bronson Commercial |
$164.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.15
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$725.31 |
| Rate for Payer: Aetna American Axle |
$356.99
|
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna Medicare |
$274.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: BCBS Complete |
$219.69
|
| Rate for Payer: BCBS Trust/PPO |
$725.31
|
| Rate for Payer: BCN Commercial |
$725.31
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$279.67
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: Priority Health Tiered Network |
$223.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.99
|
| Rate for Payer: UHC Core |
$286.14
|
| Rate for Payer: UHC Exchange |
$215.84
|
| Rate for Payer: UMR Bronson Commercial |
$203.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$549.22
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.66 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna American Axle |
$356.99
|
| Rate for Payer: Aetna Commercial |
$466.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.99
|
| Rate for Payer: Cash Price |
$439.38
|
| Rate for Payer: Cofinity Advantage |
$384.45
|
| Rate for Payer: Cofinity Commercial |
$472.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.38
|
| Rate for Payer: Healthscope Commercial |
$494.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.92
|
| Rate for Payer: PHP Commercial |
$466.84
|
| Rate for Payer: Priority Health SBD |
$346.01
|
| Rate for Payer: UMR Bronson Commercial |
$241.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.92
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Aetna American Axle |
$122.69
|
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Advantage |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health SBD |
$118.92
|
| Rate for Payer: UMR Bronson Commercial |
$83.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$188.76
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$190.78 |
| Rate for Payer: Aetna American Axle |
$122.69
|
| Rate for Payer: Aetna Commercial |
$160.45
|
| Rate for Payer: Aetna Medicare |
$94.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.69
|
| Rate for Payer: BCBS Complete |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$190.78
|
| Rate for Payer: BCN Commercial |
$190.78
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cash Price |
$151.01
|
| Rate for Payer: Cofinity Advantage |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$162.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.01
|
| Rate for Payer: Healthscope Commercial |
$169.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.57
|
| Rate for Payer: PHP Commercial |
$160.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.56
|
| Rate for Payer: Priority Health SBD |
$118.92
|
| Rate for Payer: Priority Health Tiered Network |
$58.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.69
|
| Rate for Payer: UHC Core |
$98.34
|
| Rate for Payer: UHC Exchange |
$74.18
|
| Rate for Payer: UMR Bronson Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.57
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$2,091.59 |
| Rate for Payer: Aetna American Axle |
$356.62
|
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: Aetna Medicare |
$274.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.62
|
| Rate for Payer: BCBS Complete |
$219.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,091.59
|
| Rate for Payer: BCN Commercial |
$2,091.59
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Advantage |
$384.06
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$806.49
|
| Rate for Payer: Priority Health SBD |
$345.65
|
| Rate for Payer: Priority Health Tiered Network |
$645.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.62
|
| Rate for Payer: UHC Core |
$285.85
|
| Rate for Payer: UHC Exchange |
$215.62
|
| Rate for Payer: UMR Bronson Commercial |
$203.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.49
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$548.65
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.41 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna American Axle |
$356.62
|
| Rate for Payer: Aetna Commercial |
$466.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.62
|
| Rate for Payer: Cash Price |
$438.92
|
| Rate for Payer: Cofinity Advantage |
$384.06
|
| Rate for Payer: Cofinity Commercial |
$471.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.92
|
| Rate for Payer: Healthscope Commercial |
$493.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.49
|
| Rate for Payer: PHP Commercial |
$466.35
|
| Rate for Payer: Priority Health SBD |
$345.65
|
| Rate for Payer: UMR Bronson Commercial |
$241.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.49
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna American Axle |
$40.22
|
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.22
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Advantage |
$43.31
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: Priority Health SBD |
$38.98
|
| Rate for Payer: UMR Bronson Commercial |
$27.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$61.87
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna American Axle |
$40.22
|
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.22
|
| Rate for Payer: BCBS Complete |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$84.31
|
| Rate for Payer: BCN Commercial |
$84.31
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cofinity Advantage |
$43.31
|
| Rate for Payer: Cofinity Commercial |
$53.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$55.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.40
|
| Rate for Payer: PHP Commercial |
$52.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32.51
|
| Rate for Payer: Priority Health SBD |
$38.98
|
| Rate for Payer: Priority Health Tiered Network |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Core |
$32.23
|
| Rate for Payer: UHC Exchange |
$24.31
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
|
