|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
IP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.97 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Aetna American Axle |
$274.73
|
| Rate for Payer: Aetna Commercial |
$359.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.73
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$295.86
|
| Rate for Payer: Cofinity Commercial |
$363.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$380.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: PHP Commercial |
$359.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: Priority Health SBD |
$266.28
|
| Rate for Payer: UMR Bronson Commercial |
$185.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.00
|
|
|
HC BRACE FRACTURE BOOT CUSTOM
|
Facility
|
OP
|
$422.66
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
27400002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Aetna American Axle |
$274.73
|
| Rate for Payer: Aetna Commercial |
$359.26
|
| Rate for Payer: Aetna Medicare |
$211.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.73
|
| Rate for Payer: BCBS Complete |
$169.06
|
| Rate for Payer: Cash Price |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$295.86
|
| Rate for Payer: Cofinity Commercial |
$363.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$380.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.26
|
| Rate for Payer: PHP Commercial |
$359.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.73
|
| Rate for Payer: Priority Health SBD |
$266.28
|
| Rate for Payer: UMR Bronson Commercial |
$156.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.00
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
IP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.16 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna American Axle |
$329.67
|
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.67
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$355.03
|
| Rate for Payer: Cofinity Commercial |
$436.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Healthscope Commercial |
$456.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: PHP Commercial |
$431.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: Priority Health SBD |
$319.52
|
| Rate for Payer: UMR Bronson Commercial |
$223.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.38
|
|
|
HC BRACE FRACTURE BOOT OTS
|
Facility
|
OP
|
$507.18
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
27400022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.66 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna American Axle |
$329.67
|
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Medicare |
$253.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.67
|
| Rate for Payer: BCBS Complete |
$202.87
|
| Rate for Payer: Cash Price |
$405.74
|
| Rate for Payer: Cofinity Commercial |
$355.03
|
| Rate for Payer: Cofinity Commercial |
$436.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.74
|
| Rate for Payer: Healthscope Commercial |
$456.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.10
|
| Rate for Payer: PHP Commercial |
$431.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.67
|
| Rate for Payer: Priority Health SBD |
$319.52
|
| Rate for Payer: UMR Bronson Commercial |
$187.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.38
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
OP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna American Axle |
$194.92
|
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Medicare |
$149.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.92
|
| Rate for Payer: BCBS Complete |
$119.95
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$209.92
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: Priority Health SBD |
$188.92
|
| Rate for Payer: UMR Bronson Commercial |
$110.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.91
|
|
|
HC BRACE HAND/FINGER ORTHOSIS
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
27400347
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna American Axle |
$194.92
|
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.92
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$209.92
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.90
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.92
|
| Rate for Payer: Priority Health SBD |
$188.92
|
| Rate for Payer: UMR Bronson Commercial |
$131.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.91
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
OP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.17 |
| Max. Negotiated Rate |
$462.56 |
| Rate for Payer: Aetna American Axle |
$334.07
|
| Rate for Payer: Aetna Commercial |
$436.87
|
| Rate for Payer: Aetna Medicare |
$256.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: BCBS Complete |
$205.58
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$359.77
|
| Rate for Payer: Cofinity Commercial |
$442.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$462.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: PHP Commercial |
$436.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: Priority Health SBD |
$323.79
|
| Rate for Payer: UMR Bronson Commercial |
$190.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.47
|
|
|
HC BRACE HAND ORTHOT W/O JNTS CF
|
Facility
|
IP
|
$513.96
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
27400044
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.14 |
| Max. Negotiated Rate |
$462.56 |
| Rate for Payer: Aetna American Axle |
$334.07
|
| Rate for Payer: Aetna Commercial |
$436.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$359.77
|
| Rate for Payer: Cofinity Commercial |
$442.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$462.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.87
|
| Rate for Payer: PHP Commercial |
$436.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.07
|
| Rate for Payer: Priority Health SBD |
$323.79
|
| Rate for Payer: UMR Bronson Commercial |
$226.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.47
|
|
|
HC BRACE HARD HELMET
|
Facility
|
IP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.15 |
| Max. Negotiated Rate |
$378.71 |
| Rate for Payer: Aetna American Axle |
$273.51
|
| Rate for Payer: Aetna Commercial |
$357.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.51
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$294.55
|
| Rate for Payer: Cofinity Commercial |
$361.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Healthscope Commercial |
$378.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: PHP Commercial |
$357.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: Priority Health SBD |
$265.10
|
| Rate for Payer: UMR Bronson Commercial |
$185.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.59
|
|
|
HC BRACE HARD HELMET
|
Facility
|
OP
|
$420.79
|
|
|
Service Code
|
HCPCS A8001
|
| Hospital Charge Code |
27000021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.69 |
| Max. Negotiated Rate |
$378.71 |
| Rate for Payer: Aetna American Axle |
$273.51
|
| Rate for Payer: Aetna Commercial |
$357.67
|
| Rate for Payer: Aetna Medicare |
$210.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.51
|
| Rate for Payer: BCBS Complete |
$168.32
|
| Rate for Payer: Cash Price |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$294.55
|
| Rate for Payer: Cofinity Commercial |
$361.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.63
|
| Rate for Payer: Healthscope Commercial |
$378.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.67
|
| Rate for Payer: PHP Commercial |
$357.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.51
|
| Rate for Payer: Priority Health SBD |
$265.10
|
| Rate for Payer: UMR Bronson Commercial |
$155.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.59
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.93 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna American Axle |
$119.34
|
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$91.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
| Rate for Payer: BCBS Complete |
$73.44
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health SBD |
$115.67
|
| Rate for Payer: UMR Bronson Commercial |
$67.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC BRACE HEEL RELIEF SHOE
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
27000467
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.78 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna American Axle |
$119.34
|
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health SBD |
$115.67
|
| Rate for Payer: UMR Bronson Commercial |
$80.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna American Axle |
$82.88
|
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.33
|
| Rate for Payer: UMR Bronson Commercial |
$47.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC BRACE HFO NONTORSION JNTS PRE CST
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
27400051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna American Axle |
$82.88
|
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.33
|
| Rate for Payer: UMR Bronson Commercial |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
OP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$232.22 |
| Rate for Payer: Aetna American Axle |
$167.71
|
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: Aetna Medicare |
$129.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.71
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$180.61
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.32
|
| Rate for Payer: PHP Commercial |
$219.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.71
|
| Rate for Payer: Priority Health SBD |
$162.55
|
| Rate for Payer: UMR Bronson Commercial |
$95.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.51
|
|
|
HC BRACE HFO W/O JOINTS CF
|
Facility
|
IP
|
$258.02
|
|
|
Service Code
|
HCPCS L3913
|
| Hospital Charge Code |
27400042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$232.22 |
| Rate for Payer: Aetna American Axle |
$167.71
|
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.71
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$180.61
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.32
|
| Rate for Payer: PHP Commercial |
$219.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.71
|
| Rate for Payer: Priority Health SBD |
$162.55
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.51
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
IP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$812.97 |
| Max. Negotiated Rate |
$1,662.90 |
| Rate for Payer: Aetna American Axle |
$1,200.99
|
| Rate for Payer: Aetna Commercial |
$1,570.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.99
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,293.37
|
| Rate for Payer: Cofinity Commercial |
$1,589.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,293.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Healthscope Commercial |
$1,662.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,293.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: PHP Commercial |
$1,570.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: Priority Health SBD |
$1,164.03
|
| Rate for Payer: UMR Bronson Commercial |
$812.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.75
|
|
|
HC BRACE HIP ABDUCTION
|
Facility
|
OP
|
$1,847.67
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$683.64 |
| Max. Negotiated Rate |
$1,662.90 |
| Rate for Payer: Aetna American Axle |
$1,200.99
|
| Rate for Payer: Aetna Commercial |
$1,570.52
|
| Rate for Payer: Aetna Medicare |
$923.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.99
|
| Rate for Payer: BCBS Complete |
$739.07
|
| Rate for Payer: Cash Price |
$1,478.14
|
| Rate for Payer: Cofinity Commercial |
$1,293.37
|
| Rate for Payer: Cofinity Commercial |
$1,589.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,293.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,478.14
|
| Rate for Payer: Healthscope Commercial |
$1,662.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,293.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.52
|
| Rate for Payer: PHP Commercial |
$1,570.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.99
|
| Rate for Payer: Priority Health SBD |
$1,164.03
|
| Rate for Payer: UMR Bronson Commercial |
$683.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.75
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
OP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$308.24 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna American Axle |
$541.50
|
| Rate for Payer: Aetna Commercial |
$708.11
|
| Rate for Payer: Aetna Medicare |
$416.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.50
|
| Rate for Payer: BCBS Complete |
$333.23
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$583.15
|
| Rate for Payer: Cofinity Commercial |
$716.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$583.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Healthscope Commercial |
$749.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: PHP Commercial |
$708.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: Priority Health SBD |
$524.83
|
| Rate for Payer: UMR Bronson Commercial |
$308.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.80
|
|
|
HC BRACE HUMERAL SLEEVE
|
Facility
|
IP
|
$833.07
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$366.55 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna American Axle |
$541.50
|
| Rate for Payer: Aetna Commercial |
$708.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.50
|
| Rate for Payer: Cash Price |
$666.46
|
| Rate for Payer: Cofinity Commercial |
$583.15
|
| Rate for Payer: Cofinity Commercial |
$716.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$583.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.46
|
| Rate for Payer: Healthscope Commercial |
$749.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.11
|
| Rate for Payer: PHP Commercial |
$708.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.50
|
| Rate for Payer: Priority Health SBD |
$524.83
|
| Rate for Payer: UMR Bronson Commercial |
$366.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.80
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
OP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$354.45 |
| Max. Negotiated Rate |
$862.16 |
| Rate for Payer: Aetna American Axle |
$622.67
|
| Rate for Payer: Aetna Commercial |
$814.27
|
| Rate for Payer: Aetna Medicare |
$478.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.67
|
| Rate for Payer: BCBS Complete |
$383.18
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$670.57
|
| Rate for Payer: Cofinity Commercial |
$823.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Healthscope Commercial |
$862.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: PHP Commercial |
$814.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: Priority Health SBD |
$603.51
|
| Rate for Payer: UMR Bronson Commercial |
$354.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.47
|
|
|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$862.16 |
| Rate for Payer: Aetna American Axle |
$622.67
|
| Rate for Payer: Aetna Commercial |
$814.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.67
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$670.57
|
| Rate for Payer: Cofinity Commercial |
$823.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Healthscope Commercial |
$862.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: PHP Commercial |
$814.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: Priority Health SBD |
$603.51
|
| Rate for Payer: UMR Bronson Commercial |
$421.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.47
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,839.28 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna American Axle |
$3,231.16
|
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: Aetna Medicare |
$2,485.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.16
|
| Rate for Payer: BCBS Complete |
$1,988.41
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$3,479.71
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,479.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health SBD |
$3,131.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,839.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,187.25 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna American Axle |
$3,231.16
|
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.16
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$3,479.71
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,479.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health SBD |
$3,131.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,187.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
OP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$512.59 |
| Max. Negotiated Rate |
$1,246.83 |
| Rate for Payer: Aetna American Axle |
$900.49
|
| Rate for Payer: Aetna Commercial |
$1,177.56
|
| Rate for Payer: Aetna Medicare |
$692.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.49
|
| Rate for Payer: BCBS Complete |
$554.15
|
| Rate for Payer: Cash Price |
$1,108.30
|
| Rate for Payer: Cofinity Commercial |
$1,191.42
|
| Rate for Payer: Cofinity Commercial |
$969.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$969.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.30
|
| Rate for Payer: Healthscope Commercial |
$1,246.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,039.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.56
|
| Rate for Payer: PHP Commercial |
$1,177.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.49
|
| Rate for Payer: Priority Health SBD |
$872.78
|
| Rate for Payer: UMR Bronson Commercial |
$512.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,039.03
|
|
