|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna American Axle |
$209.28
|
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna Medicare |
$160.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.28
|
| Rate for Payer: BCBS Complete |
$128.79
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Advantage |
$225.38
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.57
|
| Rate for Payer: Priority Health SBD |
$202.84
|
| Rate for Payer: Priority Health Tiered Network |
$174.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.28
|
| Rate for Payer: UHC Core |
$167.75
|
| Rate for Payer: UHC Exchange |
$126.53
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.48
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$321.97
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna American Axle |
$209.28
|
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.28
|
| Rate for Payer: Cash Price |
$257.58
|
| Rate for Payer: Cofinity Advantage |
$225.38
|
| Rate for Payer: Cofinity Commercial |
$276.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.58
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.48
|
| Rate for Payer: PHP Commercial |
$273.67
|
| Rate for Payer: Priority Health SBD |
$202.84
|
| Rate for Payer: UMR Bronson Commercial |
$141.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.48
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$211.60 |
| Rate for Payer: Aetna American Axle |
$104.16
|
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$80.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: BCBS Complete |
$64.10
|
| Rate for Payer: BCBS Trust/PPO |
$211.60
|
| Rate for Payer: BCN Commercial |
$211.60
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.59
|
| Rate for Payer: Priority Health SBD |
$100.95
|
| Rate for Payer: Priority Health Tiered Network |
$65.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.16
|
| Rate for Payer: UHC Core |
$83.49
|
| Rate for Payer: UHC Exchange |
$62.97
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.18
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.51 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna American Axle |
$104.16
|
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health SBD |
$100.95
|
| Rate for Payer: UMR Bronson Commercial |
$70.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.18
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.61 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Aetna American Axle |
$73.28
|
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.28
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Advantage |
$78.92
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: Priority Health SBD |
$71.03
|
| Rate for Payer: UMR Bronson Commercial |
$49.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.56
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Aetna American Axle |
$73.28
|
| Rate for Payer: Aetna Commercial |
$95.83
|
| Rate for Payer: Aetna Medicare |
$56.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.28
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$148.85
|
| Rate for Payer: BCN Commercial |
$148.85
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cash Price |
$90.19
|
| Rate for Payer: Cofinity Advantage |
$78.92
|
| Rate for Payer: Cofinity Commercial |
$96.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.56
|
| Rate for Payer: PHP Commercial |
$95.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.40
|
| Rate for Payer: Priority Health SBD |
$71.03
|
| Rate for Payer: Priority Health Tiered Network |
$45.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.28
|
| Rate for Payer: UHC Core |
$58.74
|
| Rate for Payer: UHC Exchange |
$44.31
|
| Rate for Payer: UMR Bronson Commercial |
$41.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.56
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$212.66 |
| Rate for Payer: Aetna American Axle |
$65.25
|
| Rate for Payer: Aetna Commercial |
$85.33
|
| Rate for Payer: Aetna Medicare |
$50.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.25
|
| Rate for Payer: BCBS Complete |
$40.16
|
| Rate for Payer: BCBS Trust/PPO |
$212.66
|
| Rate for Payer: BCN Commercial |
$212.66
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Advantage |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$86.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$90.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: PHP Commercial |
$85.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$63.25
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.25
|
| Rate for Payer: UHC Core |
$52.30
|
| Rate for Payer: UHC Exchange |
$39.45
|
| Rate for Payer: UMR Bronson Commercial |
$37.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.29
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$100.39
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna American Axle |
$65.25
|
| Rate for Payer: Aetna Commercial |
$85.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.25
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Cofinity Advantage |
$70.27
|
| Rate for Payer: Cofinity Commercial |
$86.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.31
|
| Rate for Payer: Healthscope Commercial |
$90.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.29
|
| Rate for Payer: PHP Commercial |
$85.33
|
| Rate for Payer: Priority Health SBD |
$63.25
|
| Rate for Payer: UMR Bronson Commercial |
$44.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.29
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,464.88 |
| Max. Negotiated Rate |
$2,996.35 |
| Rate for Payer: Aetna American Axle |
$2,164.03
|
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,164.03
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Advantage |
$2,330.50
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,330.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,496.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: Priority Health SBD |
$2,097.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,464.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,496.96
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,329.28
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,231.83 |
| Max. Negotiated Rate |
$6,521.93 |
| Rate for Payer: Aetna American Axle |
$2,164.03
|
| Rate for Payer: Aetna Commercial |
$2,829.89
|
| Rate for Payer: Aetna Medicare |
$1,664.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,164.03
|
| Rate for Payer: BCBS Complete |
$1,331.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,521.93
|
| Rate for Payer: BCN Commercial |
$6,521.93
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cofinity Advantage |
$2,330.50
|
| Rate for Payer: Cofinity Commercial |
$2,863.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,663.42
|
| Rate for Payer: Healthscope Commercial |
$2,996.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,330.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,496.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,663.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,829.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.96
|
| Rate for Payer: PHP Commercial |
$2,829.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,514.79
|
| Rate for Payer: Priority Health SBD |
$2,097.45
|
| Rate for Payer: Priority Health Tiered Network |
$2,011.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,164.03
|
| Rate for Payer: UHC Core |
$1,734.55
|
| Rate for Payer: UHC Exchange |
$1,308.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,231.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,496.96
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,138.49 |
| Max. Negotiated Rate |
$4,737.65 |
| Rate for Payer: Aetna American Axle |
$2,000.06
|
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: Aetna Medicare |
$1,538.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.06
|
| Rate for Payer: BCBS Complete |
$1,230.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,737.65
|
| Rate for Payer: BCN Commercial |
$4,737.65
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Advantage |
$2,153.91
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,153.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,307.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,461.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,826.79
|
| Rate for Payer: Priority Health SBD |
$1,938.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,461.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,000.06
|
| Rate for Payer: UHC Core |
$1,603.12
|
| Rate for Payer: UHC Exchange |
$1,209.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,307.76
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,077.01
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,353.88 |
| Max. Negotiated Rate |
$2,769.31 |
| Rate for Payer: Aetna American Axle |
$2,000.06
|
| Rate for Payer: Aetna Commercial |
$2,615.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.06
|
| Rate for Payer: Cash Price |
$2,461.61
|
| Rate for Payer: Cofinity Advantage |
$2,153.91
|
| Rate for Payer: Cofinity Commercial |
$2,646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,461.61
|
| Rate for Payer: Healthscope Commercial |
$2,769.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,153.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,307.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,615.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,307.76
|
| Rate for Payer: PHP Commercial |
$2,615.46
|
| Rate for Payer: Priority Health SBD |
$1,938.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,353.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,307.76
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$3,199.46 |
| Rate for Payer: Aetna American Axle |
$1,328.35
|
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: Aetna Medicare |
$1,021.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.35
|
| Rate for Payer: BCBS Complete |
$817.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,199.46
|
| Rate for Payer: BCN Commercial |
$3,199.46
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Advantage |
$1,430.53
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,430.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,532.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,634.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,233.68
|
| Rate for Payer: Priority Health SBD |
$1,287.47
|
| Rate for Payer: Priority Health Tiered Network |
$986.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,328.35
|
| Rate for Payer: UHC Core |
$1,064.72
|
| Rate for Payer: UHC Exchange |
$803.14
|
| Rate for Payer: UMR Bronson Commercial |
$756.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,532.71
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,043.61
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$899.19 |
| Max. Negotiated Rate |
$1,839.25 |
| Rate for Payer: Aetna American Axle |
$1,328.35
|
| Rate for Payer: Aetna Commercial |
$1,737.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.35
|
| Rate for Payer: Cash Price |
$1,634.89
|
| Rate for Payer: Cofinity Advantage |
$1,430.53
|
| Rate for Payer: Cofinity Commercial |
$1,757.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.89
|
| Rate for Payer: Healthscope Commercial |
$1,839.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,430.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,532.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.71
|
| Rate for Payer: PHP Commercial |
$1,737.07
|
| Rate for Payer: Priority Health SBD |
$1,287.47
|
| Rate for Payer: UMR Bronson Commercial |
$899.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,532.71
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna American Axle |
$31.79
|
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Advantage |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: UMR Bronson Commercial |
$21.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.67
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$1,139.44 |
| Rate for Payer: Aetna American Axle |
$31.79
|
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: BCBS Complete |
$19.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.44
|
| Rate for Payer: BCN Commercial |
$1,139.44
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Advantage |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.35
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Priority Health Tiered Network |
$351.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.79
|
| Rate for Payer: UHC Core |
$25.48
|
| Rate for Payer: UHC Exchange |
$19.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.67
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$212.66 |
| Rate for Payer: Aetna American Axle |
$23.97
|
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna Medicare |
$18.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.66
|
| Rate for Payer: BCN Commercial |
$212.66
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Advantage |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$23.23
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.97
|
| Rate for Payer: UHC Core |
$19.21
|
| Rate for Payer: UHC Exchange |
$14.49
|
| Rate for Payer: UMR Bronson Commercial |
$13.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.65
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.87
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$33.18 |
| Rate for Payer: Aetna American Axle |
$23.97
|
| Rate for Payer: Aetna Commercial |
$31.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.97
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cofinity Advantage |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$31.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$33.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.65
|
| Rate for Payer: PHP Commercial |
$31.34
|
| Rate for Payer: Priority Health SBD |
$23.23
|
| Rate for Payer: UMR Bronson Commercial |
$16.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.65
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna American Axle |
$97.81
|
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.81
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Advantage |
$105.33
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: Priority Health SBD |
$94.80
|
| Rate for Payer: UMR Bronson Commercial |
$66.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.85
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$150.47
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$195.22 |
| Rate for Payer: Aetna American Axle |
$97.81
|
| Rate for Payer: Aetna Commercial |
$127.90
|
| Rate for Payer: Aetna Medicare |
$75.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.81
|
| Rate for Payer: BCBS Complete |
$60.19
|
| Rate for Payer: BCBS Trust/PPO |
$195.22
|
| Rate for Payer: BCN Commercial |
$195.22
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cash Price |
$120.38
|
| Rate for Payer: Cofinity Advantage |
$105.33
|
| Rate for Payer: Cofinity Commercial |
$129.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$135.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.85
|
| Rate for Payer: PHP Commercial |
$127.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75.28
|
| Rate for Payer: Priority Health SBD |
$94.80
|
| Rate for Payer: Priority Health Tiered Network |
$60.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.81
|
| Rate for Payer: UHC Core |
$78.39
|
| Rate for Payer: UHC Exchange |
$59.13
|
| Rate for Payer: UMR Bronson Commercial |
$55.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.85
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.22 |
| Max. Negotiated Rate |
$311.36 |
| Rate for Payer: Aetna American Axle |
$224.87
|
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.87
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Advantage |
$242.16
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: Priority Health SBD |
$217.95
|
| Rate for Payer: UMR Bronson Commercial |
$152.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.46
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$345.95
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$1,033.31 |
| Rate for Payer: Aetna American Axle |
$224.87
|
| Rate for Payer: Aetna Commercial |
$294.06
|
| Rate for Payer: Aetna Medicare |
$172.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.87
|
| Rate for Payer: BCBS Complete |
$138.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.31
|
| Rate for Payer: BCN Commercial |
$1,033.31
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cash Price |
$276.76
|
| Rate for Payer: Cofinity Advantage |
$242.16
|
| Rate for Payer: Cofinity Commercial |
$297.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.76
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.46
|
| Rate for Payer: PHP Commercial |
$294.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$398.43
|
| Rate for Payer: Priority Health SBD |
$217.95
|
| Rate for Payer: Priority Health Tiered Network |
$318.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.87
|
| Rate for Payer: UHC Core |
$180.24
|
| Rate for Payer: UHC Exchange |
$135.96
|
| Rate for Payer: UMR Bronson Commercial |
$128.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.46
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$443.17 |
| Rate for Payer: Aetna American Axle |
$320.07
|
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.07
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Advantage |
$344.69
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: Priority Health SBD |
$310.22
|
| Rate for Payer: UMR Bronson Commercial |
$216.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.31
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$492.41
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.19 |
| Max. Negotiated Rate |
$1,469.94 |
| Rate for Payer: Aetna American Axle |
$320.07
|
| Rate for Payer: Aetna Commercial |
$418.55
|
| Rate for Payer: Aetna Medicare |
$246.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.07
|
| Rate for Payer: BCBS Complete |
$196.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.94
|
| Rate for Payer: BCN Commercial |
$1,469.94
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cash Price |
$393.93
|
| Rate for Payer: Cofinity Advantage |
$344.69
|
| Rate for Payer: Cofinity Commercial |
$423.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.93
|
| Rate for Payer: Healthscope Commercial |
$443.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.31
|
| Rate for Payer: PHP Commercial |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$566.79
|
| Rate for Payer: Priority Health SBD |
$310.22
|
| Rate for Payer: Priority Health Tiered Network |
$453.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.07
|
| Rate for Payer: UHC Core |
$256.55
|
| Rate for Payer: UHC Exchange |
$193.52
|
| Rate for Payer: UMR Bronson Commercial |
$182.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.31
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,361.71
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$873.83 |
| Max. Negotiated Rate |
$2,876.53 |
| Rate for Payer: Aetna American Axle |
$1,535.11
|
| Rate for Payer: Aetna Commercial |
$2,007.45
|
| Rate for Payer: Aetna Medicare |
$1,180.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.11
|
| Rate for Payer: BCBS Complete |
$944.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,876.53
|
| Rate for Payer: BCN Commercial |
$2,876.53
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cash Price |
$1,889.37
|
| Rate for Payer: Cofinity Advantage |
$1,653.20
|
| Rate for Payer: Cofinity Commercial |
$2,031.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.37
|
| Rate for Payer: Healthscope Commercial |
$2,125.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,889.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,771.28
|
| Rate for Payer: PHP Commercial |
$2,007.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,109.16
|
| Rate for Payer: Priority Health SBD |
$1,487.88
|
| Rate for Payer: Priority Health Tiered Network |
$887.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,535.11
|
| Rate for Payer: UHC Core |
$1,230.45
|
| Rate for Payer: UHC Exchange |
$928.15
|
| Rate for Payer: UMR Bronson Commercial |
$873.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.28
|
|
