|
HC BRACE KNEE HINGED CUSTOM
|
Facility
|
IP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.56 |
| 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 New Business (MI Preferred) |
$900.49
|
| 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 |
$609.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,039.03
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
IP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$717.14 |
| Max. Negotiated Rate |
$1,466.87 |
| Rate for Payer: Aetna American Axle |
$1,059.41
|
| Rate for Payer: Aetna Commercial |
$1,385.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.41
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,140.90
|
| Rate for Payer: Cofinity Commercial |
$1,401.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,140.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Healthscope Commercial |
$1,466.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,140.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: PHP Commercial |
$1,385.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: Priority Health SBD |
$1,026.81
|
| Rate for Payer: UMR Bronson Commercial |
$717.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.39
|
|
|
HC BRACE KNEE HINGED OTS
|
Facility
|
OP
|
$1,629.86
|
|
|
Service Code
|
HCPCS L1833
|
| Hospital Charge Code |
27400021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$603.05 |
| Max. Negotiated Rate |
$1,466.87 |
| Rate for Payer: Aetna American Axle |
$1,059.41
|
| Rate for Payer: Aetna Commercial |
$1,385.38
|
| Rate for Payer: Aetna Medicare |
$814.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.41
|
| Rate for Payer: BCBS Complete |
$651.94
|
| Rate for Payer: Cash Price |
$1,303.89
|
| Rate for Payer: Cofinity Commercial |
$1,140.90
|
| Rate for Payer: Cofinity Commercial |
$1,401.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,140.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.89
|
| Rate for Payer: Healthscope Commercial |
$1,466.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,140.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.38
|
| Rate for Payer: PHP Commercial |
$1,385.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.41
|
| Rate for Payer: Priority Health SBD |
$1,026.81
|
| Rate for Payer: UMR Bronson Commercial |
$603.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.39
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
OP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$182.55 |
| Rate for Payer: Aetna American Axle |
$131.84
|
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Medicare |
$101.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.84
|
| Rate for Payer: BCBS Complete |
$81.13
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$174.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$182.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: PHP Commercial |
$172.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health SBD |
$127.78
|
| Rate for Payer: UMR Bronson Commercial |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.12
|
|
|
HC BRACE KNEE IMMOBILIZER
|
Facility
|
IP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$182.55 |
| Rate for Payer: Aetna American Axle |
$131.84
|
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.84
|
| Rate for Payer: Cash Price |
$162.26
|
| Rate for Payer: Cofinity Commercial |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$174.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$182.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.41
|
| Rate for Payer: PHP Commercial |
$172.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health SBD |
$127.78
|
| Rate for Payer: UMR Bronson Commercial |
$89.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.12
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
OP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$241.16 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna American Axle |
$423.66
|
| Rate for Payer: Aetna Commercial |
$554.01
|
| Rate for Payer: Aetna Medicare |
$325.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.66
|
| Rate for Payer: BCBS Complete |
$260.71
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$456.25
|
| Rate for Payer: Cofinity Commercial |
$560.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$456.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Healthscope Commercial |
$586.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$456.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: PHP Commercial |
$554.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: Priority Health SBD |
$410.62
|
| Rate for Payer: UMR Bronson Commercial |
$241.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.83
|
|
|
HC BRACE LO SAG RGD A&P L1-L5 PREFAB
|
Facility
|
IP
|
$651.78
|
|
|
Service Code
|
HCPCS L0627
|
| Hospital Charge Code |
27400025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna American Axle |
$423.66
|
| Rate for Payer: Aetna Commercial |
$554.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.66
|
| Rate for Payer: Cash Price |
$521.42
|
| Rate for Payer: Cofinity Commercial |
$456.25
|
| Rate for Payer: Cofinity Commercial |
$560.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$456.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.42
|
| Rate for Payer: Healthscope Commercial |
$586.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$456.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.01
|
| Rate for Payer: PHP Commercial |
$554.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.66
|
| Rate for Payer: Priority Health SBD |
$410.62
|
| Rate for Payer: UMR Bronson Commercial |
$286.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.83
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.68 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$129.95
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health SBD |
$116.95
|
| Rate for Payer: UMR Bronson Commercial |
$81.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
HC BRACE LS CORSET CUSTOM
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
HCPCS L0626
|
| Hospital Charge Code |
27400005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$129.95
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health SBD |
$116.95
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
IP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.76 |
| Max. Negotiated Rate |
$175.43 |
| Rate for Payer: Aetna American Axle |
$126.70
|
| Rate for Payer: Aetna Commercial |
$165.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.70
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$167.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Healthscope Commercial |
$175.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: PHP Commercial |
$165.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health SBD |
$122.80
|
| Rate for Payer: UMR Bronson Commercial |
$85.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.19
|
|
|
HC BRACE LS CORSET OTS
|
Facility
|
OP
|
$194.92
|
|
|
Service Code
|
HCPCS L0641
|
| Hospital Charge Code |
27400019
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$175.43 |
| Rate for Payer: Aetna American Axle |
$126.70
|
| Rate for Payer: Aetna Commercial |
$165.68
|
| Rate for Payer: Aetna Medicare |
$97.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.70
|
| Rate for Payer: BCBS Complete |
$77.97
|
| Rate for Payer: Cash Price |
$155.94
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$167.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.94
|
| Rate for Payer: Healthscope Commercial |
$175.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.68
|
| Rate for Payer: PHP Commercial |
$165.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health SBD |
$122.80
|
| Rate for Payer: UMR Bronson Commercial |
$72.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.19
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
OP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$945.17 |
| Max. Negotiated Rate |
$2,299.06 |
| Rate for Payer: Aetna American Axle |
$1,660.43
|
| Rate for Payer: Aetna Commercial |
$2,171.33
|
| Rate for Payer: Aetna Medicare |
$1,277.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,660.43
|
| Rate for Payer: BCBS Complete |
$1,021.80
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$1,788.16
|
| Rate for Payer: Cofinity Commercial |
$2,196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Healthscope Commercial |
$2,299.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,915.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: PHP Commercial |
$2,171.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: Priority Health SBD |
$1,609.34
|
| Rate for Payer: UMR Bronson Commercial |
$945.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,915.88
|
|
|
HC BRACE LSO CUSTOM
|
Facility
|
IP
|
$2,554.51
|
|
| Hospital Charge Code |
27400006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,123.98 |
| Max. Negotiated Rate |
$2,299.06 |
| Rate for Payer: Aetna American Axle |
$1,660.43
|
| Rate for Payer: Aetna Commercial |
$2,171.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,660.43
|
| Rate for Payer: Cash Price |
$2,043.61
|
| Rate for Payer: Cofinity Commercial |
$1,788.16
|
| Rate for Payer: Cofinity Commercial |
$2,196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,043.61
|
| Rate for Payer: Healthscope Commercial |
$2,299.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,915.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.33
|
| Rate for Payer: PHP Commercial |
$2,171.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.43
|
| Rate for Payer: Priority Health SBD |
$1,609.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,123.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,915.88
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
IP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,196.48 |
| Max. Negotiated Rate |
$2,447.35 |
| Rate for Payer: Aetna American Axle |
$1,767.53
|
| Rate for Payer: Aetna Commercial |
$2,311.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,767.53
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$1,903.50
|
| Rate for Payer: Cofinity Commercial |
$2,338.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,903.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Commercial |
$2,447.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,903.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,039.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: PHP Commercial |
$2,311.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: Priority Health SBD |
$1,713.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,196.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,039.46
|
|
|
HC BRACE LSO SC CTRL RIGID AP PNL CSTM
|
Facility
|
OP
|
$2,719.28
|
|
|
Service Code
|
HCPCS L0637
|
| Hospital Charge Code |
27400046
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,006.13 |
| Max. Negotiated Rate |
$2,447.35 |
| Rate for Payer: Aetna American Axle |
$1,767.53
|
| Rate for Payer: Aetna Commercial |
$2,311.39
|
| Rate for Payer: Aetna Medicare |
$1,359.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,767.53
|
| Rate for Payer: BCBS Complete |
$1,087.71
|
| Rate for Payer: Cash Price |
$2,175.42
|
| Rate for Payer: Cofinity Commercial |
$1,903.50
|
| Rate for Payer: Cofinity Commercial |
$2,338.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,903.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Commercial |
$2,447.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,903.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,039.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,311.39
|
| Rate for Payer: PHP Commercial |
$2,311.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.53
|
| Rate for Payer: Priority Health SBD |
$1,713.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,006.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,039.46
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
OP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.57 |
| Max. Negotiated Rate |
$334.63 |
| Rate for Payer: Aetna American Axle |
$241.68
|
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: Aetna Medicare |
$185.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.68
|
| Rate for Payer: BCBS Complete |
$148.72
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$260.27
|
| Rate for Payer: Cofinity Commercial |
$319.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Healthscope Commercial |
$334.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: PHP Commercial |
$316.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health SBD |
$234.24
|
| Rate for Payer: UMR Bronson Commercial |
$137.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.86
|
|
|
HC BRACE PAVLIK HARNESS CUSTOM
|
Facility
|
IP
|
$371.81
|
|
|
Service Code
|
HCPCS L1620
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$334.63 |
| Rate for Payer: Aetna American Axle |
$241.68
|
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.68
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cofinity Commercial |
$260.27
|
| Rate for Payer: Cofinity Commercial |
$319.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.45
|
| Rate for Payer: Healthscope Commercial |
$334.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.04
|
| Rate for Payer: PHP Commercial |
$316.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health SBD |
$234.24
|
| Rate for Payer: UMR Bronson Commercial |
$163.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.86
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
IP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna American Axle |
$258.11
|
| Rate for Payer: Aetna Commercial |
$337.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.11
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$277.96
|
| Rate for Payer: Cofinity Commercial |
$341.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: PHP Commercial |
$337.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: Priority Health SBD |
$250.17
|
| Rate for Payer: UMR Bronson Commercial |
$174.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
HC BRACE PRAFO CUSTOM
|
Facility
|
OP
|
$397.09
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna American Axle |
$258.11
|
| Rate for Payer: Aetna Commercial |
$337.53
|
| Rate for Payer: Aetna Medicare |
$198.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.11
|
| Rate for Payer: BCBS Complete |
$158.84
|
| Rate for Payer: Cash Price |
$317.67
|
| Rate for Payer: Cofinity Commercial |
$277.96
|
| Rate for Payer: Cofinity Commercial |
$341.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.53
|
| Rate for Payer: PHP Commercial |
$337.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.11
|
| Rate for Payer: Priority Health SBD |
$250.17
|
| Rate for Payer: UMR Bronson Commercial |
$146.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
OP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.61 |
| Max. Negotiated Rate |
$393.11 |
| Rate for Payer: Aetna American Axle |
$283.91
|
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: Aetna Medicare |
$218.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.91
|
| Rate for Payer: BCBS Complete |
$174.72
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$305.75
|
| Rate for Payer: Cofinity Commercial |
$375.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Healthscope Commercial |
$393.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: PHP Commercial |
$371.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: Priority Health SBD |
$275.18
|
| Rate for Payer: UMR Bronson Commercial |
$161.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.59
|
|
|
HC BRACE PRAFO OTS
|
Facility
|
IP
|
$436.79
|
|
|
Service Code
|
HCPCS L4397
|
| Hospital Charge Code |
27000456
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$192.19 |
| Max. Negotiated Rate |
$393.11 |
| Rate for Payer: Aetna American Axle |
$283.91
|
| Rate for Payer: Aetna Commercial |
$371.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.91
|
| Rate for Payer: Cash Price |
$349.43
|
| Rate for Payer: Cofinity Commercial |
$305.75
|
| Rate for Payer: Cofinity Commercial |
$375.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.43
|
| Rate for Payer: Healthscope Commercial |
$393.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.27
|
| Rate for Payer: PHP Commercial |
$371.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.91
|
| Rate for Payer: Priority Health SBD |
$275.18
|
| Rate for Payer: UMR Bronson Commercial |
$192.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.59
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
IP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$484.61 |
| Rate for Payer: Aetna American Axle |
$349.99
|
| Rate for Payer: Aetna Commercial |
$457.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.99
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$376.92
|
| Rate for Payer: Cofinity Commercial |
$463.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Healthscope Commercial |
$484.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: PHP Commercial |
$457.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: Priority Health SBD |
$339.22
|
| Rate for Payer: UMR Bronson Commercial |
$236.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.84
|
|
|
HC BRACE RESTING NIGHTSPLINT CUSTOM
|
Facility
|
OP
|
$538.45
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
27000200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.23 |
| Max. Negotiated Rate |
$484.61 |
| Rate for Payer: Aetna American Axle |
$349.99
|
| Rate for Payer: Aetna Commercial |
$457.68
|
| Rate for Payer: Aetna Medicare |
$269.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.99
|
| Rate for Payer: BCBS Complete |
$215.38
|
| Rate for Payer: Cash Price |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$376.92
|
| Rate for Payer: Cofinity Commercial |
$463.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.76
|
| Rate for Payer: Healthscope Commercial |
$484.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.68
|
| Rate for Payer: PHP Commercial |
$457.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.99
|
| Rate for Payer: Priority Health SBD |
$339.22
|
| Rate for Payer: UMR Bronson Commercial |
$199.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.84
|
|
|
HC BRACE RIGID NECK
|
Facility
|
OP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.47 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna American Axle |
$120.29
|
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: Aetna Medicare |
$92.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.29
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$129.54
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: Priority Health SBD |
$116.59
|
| Rate for Payer: UMR Bronson Commercial |
$68.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.79
|
|
|
HC BRACE RIGID NECK
|
Facility
|
IP
|
$185.06
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
27400009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$166.55 |
| Rate for Payer: Aetna American Axle |
$120.29
|
| Rate for Payer: Aetna Commercial |
$157.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.29
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$129.54
|
| Rate for Payer: Cofinity Commercial |
$159.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.05
|
| Rate for Payer: Healthscope Commercial |
$166.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: PHP Commercial |
$157.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.29
|
| Rate for Payer: Priority Health SBD |
$116.59
|
| Rate for Payer: UMR Bronson Commercial |
$81.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.79
|
|
