|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$147.44
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$132.70 |
| Rate for Payer: Aetna American Axle |
$95.84
|
| Rate for Payer: Aetna Commercial |
$125.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.84
|
| Rate for Payer: Cash Price |
$117.95
|
| Rate for Payer: Cofinity Commercial |
$103.21
|
| Rate for Payer: Cofinity Commercial |
$126.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.95
|
| Rate for Payer: Healthscope Commercial |
$132.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: PHP Commercial |
$125.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.84
|
| Rate for Payer: Priority Health SBD |
$92.89
|
| Rate for Payer: UMR Bronson Commercial |
$64.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.58
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.47 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna American Axle |
$222.17
|
| Rate for Payer: Aetna Commercial |
$290.53
|
| Rate for Payer: Aetna Medicare |
$170.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.17
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS Trust/PPO |
$441.00
|
| Rate for Payer: BCN Commercial |
$441.00
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$239.26
|
| Rate for Payer: Cofinity Commercial |
$293.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Healthscope Commercial |
$307.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: PHP Commercial |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.64
|
| Rate for Payer: Priority Health Narrow Network |
$136.51
|
| Rate for Payer: Priority Health SBD |
$215.33
|
| Rate for Payer: UMR Bronson Commercial |
$126.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.35
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$341.80
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.39 |
| Max. Negotiated Rate |
$307.62 |
| Rate for Payer: Aetna American Axle |
$222.17
|
| Rate for Payer: Aetna Commercial |
$290.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.17
|
| Rate for Payer: Cash Price |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$239.26
|
| Rate for Payer: Cofinity Commercial |
$293.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.44
|
| Rate for Payer: Healthscope Commercial |
$307.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.53
|
| Rate for Payer: PHP Commercial |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.17
|
| Rate for Payer: Priority Health SBD |
$215.33
|
| Rate for Payer: UMR Bronson Commercial |
$150.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.35
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$65.07
|
| Rate for Payer: BCN Commercial |
$65.07
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.18
|
| Rate for Payer: Priority Health Narrow Network |
$20.14
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.51
|
| Rate for Payer: UHC Exchange |
$24.59
|
| Rate for Payer: UMR Bronson Commercial |
$111.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.52
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.31
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UMR Bronson Commercial |
$132.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.52
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna American Axle |
$62.43
|
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.43
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$67.24
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health SBD |
$60.51
|
| Rate for Payer: UMR Bronson Commercial |
$42.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
HC BRACE BK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$96.05
|
|
|
Service Code
|
HCPCS L8470
|
| Hospital Charge Code |
27400032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna American Axle |
$62.43
|
| Rate for Payer: Aetna Commercial |
$81.64
|
| Rate for Payer: Aetna Medicare |
$48.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.43
|
| Rate for Payer: BCBS Complete |
$38.42
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$20.69
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cash Price |
$76.84
|
| Rate for Payer: Cofinity Commercial |
$67.24
|
| Rate for Payer: Cofinity Commercial |
$82.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.84
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.64
|
| Rate for Payer: PHP Commercial |
$81.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.01
|
| Rate for Payer: Priority Health Narrow Network |
$6.41
|
| Rate for Payer: Priority Health SBD |
$60.51
|
| Rate for Payer: UMR Bronson Commercial |
$35.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.04
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.36 |
| Max. Negotiated Rate |
$1,009.14 |
| Rate for Payer: Aetna American Axle |
$728.83
|
| Rate for Payer: Aetna Commercial |
$953.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.83
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$784.89
|
| Rate for Payer: Cofinity Commercial |
$964.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Healthscope Commercial |
$1,009.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$784.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: PHP Commercial |
$953.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: Priority Health SBD |
$706.40
|
| Rate for Payer: UMR Bronson Commercial |
$493.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.95
|
|
|
HC BRACE BK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,121.27
|
|
|
Service Code
|
HCPCS L5450
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.87 |
| Max. Negotiated Rate |
$1,475.50 |
| Rate for Payer: Aetna American Axle |
$728.83
|
| Rate for Payer: Aetna Commercial |
$953.08
|
| Rate for Payer: Aetna Medicare |
$560.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.83
|
| Rate for Payer: BCBS Complete |
$448.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.50
|
| Rate for Payer: BCN Commercial |
$1,475.50
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cash Price |
$897.02
|
| Rate for Payer: Cofinity Commercial |
$784.89
|
| Rate for Payer: Cofinity Commercial |
$964.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.02
|
| Rate for Payer: Healthscope Commercial |
$1,009.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$784.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.08
|
| Rate for Payer: PHP Commercial |
$953.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.93
|
| Rate for Payer: Priority Health Narrow Network |
$456.74
|
| Rate for Payer: Priority Health SBD |
$706.40
|
| Rate for Payer: UMR Bronson Commercial |
$414.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.95
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
OP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$465.84 |
| Max. Negotiated Rate |
$1,656.83 |
| Rate for Payer: Aetna American Axle |
$818.36
|
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: Aetna Medicare |
$629.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.36
|
| Rate for Payer: BCBS Complete |
$503.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.83
|
| Rate for Payer: BCN Commercial |
$1,656.83
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,082.76
|
| Rate for Payer: Cofinity Commercial |
$881.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Healthscope Commercial |
$1,133.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: PHP Commercial |
$1,070.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.10
|
| Rate for Payer: Priority Health Narrow Network |
$512.88
|
| Rate for Payer: Priority Health SBD |
$793.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.28
|
| Rate for Payer: UHC Exchange |
$626.07
|
| Rate for Payer: UMR Bronson Commercial |
$465.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.26
|
|
|
HC BRACE CERVICAL COLLAR CUSTOM
|
Facility
|
IP
|
$1,259.02
|
|
|
Service Code
|
HCPCS L0190
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$553.97 |
| Max. Negotiated Rate |
$1,133.12 |
| Rate for Payer: Healthscope Commercial |
$1,133.12
|
| Rate for Payer: Aetna American Axle |
$818.36
|
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.36
|
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Cofinity Commercial |
$1,082.76
|
| Rate for Payer: Cofinity Commercial |
$881.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.17
|
| Rate for Payer: PHP Commercial |
$1,070.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.36
|
| Rate for Payer: Priority Health SBD |
$793.18
|
| Rate for Payer: UMR Bronson Commercial |
$553.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.26
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$396.27 |
| Max. Negotiated Rate |
$1,255.37 |
| Rate for Payer: Aetna American Axle |
$696.15
|
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.37
|
| Rate for Payer: BCN Commercial |
$1,255.37
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UMR Bronson Commercial |
$396.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC BRACE CERVICAL THORA EXTENSION
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna American Axle |
$696.15
|
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UMR Bronson Commercial |
$471.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
IP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,588.40 |
| Max. Negotiated Rate |
$5,294.46 |
| Rate for Payer: Cofinity Commercial |
$4,117.91
|
| Rate for Payer: Cofinity Commercial |
$5,059.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,117.91
|
| Rate for Payer: Aetna American Axle |
$3,823.77
|
| Rate for Payer: Aetna Commercial |
$5,000.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,823.77
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Healthscope Commercial |
$5,294.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,117.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,412.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: PHP Commercial |
$5,000.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: Priority Health SBD |
$3,706.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,588.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,412.05
|
|
|
HC BRACE CTLSO CUSTOM
|
Facility
|
OP
|
$5,882.73
|
|
| Hospital Charge Code |
27000032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,176.61 |
| Max. Negotiated Rate |
$5,294.46 |
| Rate for Payer: Aetna American Axle |
$3,823.77
|
| Rate for Payer: Aetna Commercial |
$5,000.32
|
| Rate for Payer: Aetna Medicare |
$2,941.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,823.77
|
| Rate for Payer: BCBS Complete |
$2,353.09
|
| Rate for Payer: Cash Price |
$4,706.18
|
| Rate for Payer: Cofinity Commercial |
$4,117.91
|
| Rate for Payer: Cofinity Commercial |
$5,059.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,117.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,706.18
|
| Rate for Payer: Healthscope Commercial |
$5,294.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,117.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,412.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.32
|
| Rate for Payer: PHP Commercial |
$5,000.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.77
|
| Rate for Payer: Priority Health SBD |
$3,706.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,176.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,412.05
|
|
|
HC BRACE CTO
|
Facility
|
OP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$548.36 |
| Max. Negotiated Rate |
$1,921.79 |
| Rate for Payer: Aetna American Axle |
$963.34
|
| Rate for Payer: Aetna Commercial |
$1,259.75
|
| Rate for Payer: Aetna Medicare |
$741.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.34
|
| Rate for Payer: BCBS Complete |
$592.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,921.79
|
| Rate for Payer: BCN Commercial |
$1,921.79
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,037.44
|
| Rate for Payer: Cofinity Commercial |
$1,274.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Healthscope Commercial |
$1,333.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: PHP Commercial |
$1,259.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.62
|
| Rate for Payer: Priority Health Narrow Network |
$594.90
|
| Rate for Payer: Priority Health SBD |
$933.70
|
| Rate for Payer: UMR Bronson Commercial |
$548.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.54
|
|
|
HC BRACE CTO
|
Facility
|
IP
|
$1,482.06
|
|
|
Service Code
|
HCPCS L0200
|
| Hospital Charge Code |
27400029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$652.11 |
| Max. Negotiated Rate |
$1,333.85 |
| Rate for Payer: Aetna American Axle |
$963.34
|
| Rate for Payer: Aetna Commercial |
$1,259.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.34
|
| Rate for Payer: Cash Price |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,037.44
|
| Rate for Payer: Cofinity Commercial |
$1,274.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.65
|
| Rate for Payer: Healthscope Commercial |
$1,333.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.75
|
| Rate for Payer: PHP Commercial |
$1,259.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.34
|
| Rate for Payer: Priority Health SBD |
$933.70
|
| Rate for Payer: UMR Bronson Commercial |
$652.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.54
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
OP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.90 |
| Max. Negotiated Rate |
$1,255.37 |
| Rate for Payer: Aetna American Axle |
$179.01
|
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$137.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.01
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.37
|
| Rate for Payer: BCN Commercial |
$1,255.37
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$192.78
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health SBD |
$173.50
|
| Rate for Payer: UMR Bronson Commercial |
$101.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
HC BRACE CTO REPLACEMENT PADS
|
Facility
|
IP
|
$275.40
|
|
|
Service Code
|
HCPCS L1499
|
| Hospital Charge Code |
27400045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$247.86 |
| Rate for Payer: Aetna American Axle |
$179.01
|
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.01
|
| Rate for Payer: Cash Price |
$220.32
|
| Rate for Payer: Cofinity Commercial |
$192.78
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.32
|
| Rate for Payer: Healthscope Commercial |
$247.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.09
|
| Rate for Payer: PHP Commercial |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.01
|
| Rate for Payer: Priority Health SBD |
$173.50
|
| Rate for Payer: UMR Bronson Commercial |
$121.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.55
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna American Axle |
$45.75
|
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: UMR Bronson Commercial |
$30.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC BRACE D RING SPLINT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$207.77 |
| Rate for Payer: Aetna American Axle |
$45.75
|
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$35.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: BCBS Complete |
$28.15
|
| Rate for Payer: BCBS Trust/PPO |
$207.77
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.39
|
| Rate for Payer: Priority Health Narrow Network |
$64.31
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.21
|
| Rate for Payer: UHC Exchange |
$78.51
|
| Rate for Payer: UMR Bronson Commercial |
$26.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
OP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.47 |
| Max. Negotiated Rate |
$1,417.25 |
| Rate for Payer: UMR Bronson Commercial |
$398.47
|
| Rate for Payer: Aetna American Axle |
$700.02
|
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna Medicare |
$538.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.02
|
| Rate for Payer: BCBS Complete |
$430.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.25
|
| Rate for Payer: BCN Commercial |
$1,417.25
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$753.86
|
| Rate for Payer: Cofinity Commercial |
$926.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$753.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Healthscope Commercial |
$969.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$753.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$807.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: PHP Commercial |
$915.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.39
|
| Rate for Payer: Priority Health Narrow Network |
$438.71
|
| Rate for Payer: Priority Health SBD |
$678.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$807.71
|
|
|
HC BRACE ELBOW ORTHOSIS
|
Facility
|
IP
|
$1,076.95
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$473.86 |
| Max. Negotiated Rate |
$969.26 |
| Rate for Payer: Aetna American Axle |
$700.02
|
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.02
|
| Rate for Payer: Cash Price |
$861.56
|
| Rate for Payer: Cofinity Commercial |
$753.86
|
| Rate for Payer: Cofinity Commercial |
$926.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$753.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$861.56
|
| Rate for Payer: Healthscope Commercial |
$969.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$753.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$807.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$915.41
|
| Rate for Payer: PHP Commercial |
$915.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.02
|
| Rate for Payer: Priority Health SBD |
$678.48
|
| Rate for Payer: UMR Bronson Commercial |
$473.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$807.71
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
OP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$2,120.69 |
| Rate for Payer: Aetna American Axle |
$454.16
|
| Rate for Payer: Aetna Commercial |
$593.90
|
| Rate for Payer: Aetna Medicare |
$349.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.16
|
| Rate for Payer: BCBS Complete |
$279.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,120.69
|
| Rate for Payer: BCN Commercial |
$2,120.69
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$489.09
|
| Rate for Payer: Cofinity Commercial |
$600.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Healthscope Commercial |
$628.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.90
|
| Rate for Payer: PHP Commercial |
$593.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.58
|
| Rate for Payer: Priority Health Narrow Network |
$656.46
|
| Rate for Payer: Priority Health SBD |
$440.18
|
| Rate for Payer: UMR Bronson Commercial |
$258.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
|
HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF
|
Facility
|
IP
|
$698.70
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
27400047
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$307.43 |
| Max. Negotiated Rate |
$628.83 |
| Rate for Payer: Aetna American Axle |
$454.16
|
| Rate for Payer: Aetna Commercial |
$593.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.16
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Cofinity Commercial |
$489.09
|
| Rate for Payer: Cofinity Commercial |
$600.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.96
|
| Rate for Payer: Healthscope Commercial |
$628.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.90
|
| Rate for Payer: PHP Commercial |
$593.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.16
|
| Rate for Payer: Priority Health SBD |
$440.18
|
| Rate for Payer: UMR Bronson Commercial |
$307.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.02
|
|
