|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
OP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$484.10 |
| Rate for Payer: Aetna American Axle |
$349.63
|
| Rate for Payer: Aetna Commercial |
$457.21
|
| Rate for Payer: Aetna Medicare |
$268.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.63
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$376.52
|
| Rate for Payer: Cofinity Commercial |
$462.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Healthscope Commercial |
$484.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: PHP Commercial |
$457.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: Priority Health SBD |
$338.87
|
| Rate for Payer: UMR Bronson Commercial |
$199.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.42
|
|
|
HC BRACE SOCKET INSERT W/O LOCK MECH
|
Facility
|
IP
|
$537.89
|
|
|
Service Code
|
HCPCS L5679
|
| Hospital Charge Code |
27400035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$236.67 |
| Max. Negotiated Rate |
$484.10 |
| Rate for Payer: Aetna American Axle |
$349.63
|
| Rate for Payer: Aetna Commercial |
$457.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.63
|
| Rate for Payer: Cash Price |
$430.31
|
| Rate for Payer: Cofinity Commercial |
$376.52
|
| Rate for Payer: Cofinity Commercial |
$462.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.31
|
| Rate for Payer: Healthscope Commercial |
$484.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.21
|
| Rate for Payer: PHP Commercial |
$457.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.63
|
| Rate for Payer: Priority Health SBD |
$338.87
|
| Rate for Payer: UMR Bronson Commercial |
$236.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.42
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
IP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.69 |
| Max. Negotiated Rate |
$54.59 |
| Rate for Payer: Aetna American Axle |
$39.43
|
| Rate for Payer: Aetna Commercial |
$51.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.43
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$42.46
|
| Rate for Payer: Cofinity Commercial |
$52.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$54.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: PHP Commercial |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: Priority Health SBD |
$38.22
|
| Rate for Payer: UMR Bronson Commercial |
$26.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.49
|
|
|
HC BRACE SOFT COLLAR
|
Facility
|
OP
|
$60.66
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
27400010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$54.59 |
| Rate for Payer: Aetna American Axle |
$39.43
|
| Rate for Payer: Aetna Commercial |
$51.56
|
| Rate for Payer: Aetna Medicare |
$30.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.43
|
| Rate for Payer: BCBS Complete |
$24.26
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cofinity Commercial |
$42.46
|
| Rate for Payer: Cofinity Commercial |
$52.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$54.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.56
|
| Rate for Payer: PHP Commercial |
$51.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.43
|
| Rate for Payer: Priority Health SBD |
$38.22
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.49
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
OP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$284.09 |
| Rate for Payer: Aetna American Axle |
$205.18
|
| Rate for Payer: Aetna Commercial |
$268.31
|
| Rate for Payer: Aetna Medicare |
$157.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.18
|
| Rate for Payer: BCBS Complete |
$126.26
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$220.96
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Healthscope Commercial |
$284.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: PHP Commercial |
$268.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: Priority Health SBD |
$198.87
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.75
|
|
|
HC BRACE SOFT HELMET
|
Facility
|
IP
|
$315.66
|
|
|
Service Code
|
HCPCS A8000
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.89 |
| Max. Negotiated Rate |
$284.09 |
| Rate for Payer: Aetna American Axle |
$205.18
|
| Rate for Payer: Aetna Commercial |
$268.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.18
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cofinity Commercial |
$220.96
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.53
|
| Rate for Payer: Healthscope Commercial |
$284.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.31
|
| Rate for Payer: PHP Commercial |
$268.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.18
|
| Rate for Payer: Priority Health SBD |
$198.87
|
| Rate for Payer: UMR Bronson Commercial |
$138.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.75
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna American Axle |
$102.11
|
| Rate for Payer: Aetna Commercial |
$133.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.11
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$109.97
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.53
|
| Rate for Payer: PHP Commercial |
$133.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| Rate for Payer: Priority Health SBD |
$98.97
|
| Rate for Payer: UMR Bronson Commercial |
$69.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.83
|
|
|
HC BRACE STUMP SHRINKER AK
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
HCPCS L8460
|
| Hospital Charge Code |
27000015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna American Axle |
$102.11
|
| Rate for Payer: Aetna Commercial |
$133.53
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.11
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$109.97
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.53
|
| Rate for Payer: PHP Commercial |
$133.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.11
|
| Rate for Payer: Priority Health SBD |
$98.97
|
| Rate for Payer: UMR Bronson Commercial |
$58.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.83
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
IP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.63 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Aetna American Axle |
$71.84
|
| Rate for Payer: Aetna Commercial |
$93.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.84
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Commercial |
$95.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: PHP Commercial |
$93.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health SBD |
$69.63
|
| Rate for Payer: UMR Bronson Commercial |
$48.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.90
|
|
|
HC BRACE STUMP SHRINKER BK
|
Facility
|
OP
|
$110.53
|
|
|
Service Code
|
HCPCS L8440
|
| Hospital Charge Code |
27000016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Aetna American Axle |
$71.84
|
| Rate for Payer: Aetna Commercial |
$93.95
|
| Rate for Payer: Aetna Medicare |
$55.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.84
|
| Rate for Payer: BCBS Complete |
$44.21
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Commercial |
$95.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.95
|
| Rate for Payer: PHP Commercial |
$93.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health SBD |
$69.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.90
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
OP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$88.58 |
| Rate for Payer: Aetna American Axle |
$63.97
|
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: Aetna Medicare |
$49.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.97
|
| Rate for Payer: BCBS Complete |
$39.37
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$84.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Healthscope Commercial |
$88.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: PHP Commercial |
$83.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health SBD |
$62.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.81
|
|
|
HC BRACE THUMB SPICA SPLINT
|
Facility
|
IP
|
$98.42
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$88.58 |
| Rate for Payer: Aetna American Axle |
$63.97
|
| Rate for Payer: Aetna Commercial |
$83.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.97
|
| Rate for Payer: Cash Price |
$78.74
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$84.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.74
|
| Rate for Payer: Healthscope Commercial |
$88.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.66
|
| Rate for Payer: PHP Commercial |
$83.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health SBD |
$62.00
|
| Rate for Payer: UMR Bronson Commercial |
$43.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.81
|
|
|
HC BRACE TLSO
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,436.16 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Aetna American Axle |
$2,121.60
|
| Rate for Payer: Aetna Commercial |
$2,774.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$2,284.80
|
| Rate for Payer: Cofinity Commercial |
$2,807.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,284.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Healthscope Commercial |
$2,937.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,284.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: PHP Commercial |
$2,774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health SBD |
$2,056.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,436.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC BRACE TLSO
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS L0486
|
| Hospital Charge Code |
27400007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,207.68 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Aetna American Axle |
$2,121.60
|
| Rate for Payer: Aetna Commercial |
$2,774.40
|
| Rate for Payer: Aetna Medicare |
$1,632.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,121.60
|
| Rate for Payer: BCBS Complete |
$1,305.60
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$2,284.80
|
| Rate for Payer: Cofinity Commercial |
$2,807.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,284.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,611.20
|
| Rate for Payer: Healthscope Commercial |
$2,937.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,284.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,448.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.40
|
| Rate for Payer: PHP Commercial |
$2,774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health SBD |
$2,056.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,207.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,448.00
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$3,016.68
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,327.34 |
| Max. Negotiated Rate |
$2,715.01 |
| Rate for Payer: Aetna American Axle |
$1,960.84
|
| Rate for Payer: Aetna Commercial |
$2,564.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,960.84
|
| Rate for Payer: Cash Price |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,111.68
|
| Rate for Payer: Cofinity Commercial |
$2,594.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,111.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,413.34
|
| Rate for Payer: Healthscope Commercial |
$2,715.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,111.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,262.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.18
|
| Rate for Payer: PHP Commercial |
$2,564.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.84
|
| Rate for Payer: Priority Health SBD |
$1,900.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,327.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,262.51
|
|
|
HC BRACE TLSO PREFAB
|
Facility
|
OP
|
$3,016.68
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,116.17 |
| Max. Negotiated Rate |
$2,715.01 |
| Rate for Payer: Aetna American Axle |
$1,960.84
|
| Rate for Payer: Aetna Commercial |
$2,564.18
|
| Rate for Payer: Aetna Medicare |
$1,508.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,960.84
|
| Rate for Payer: BCBS Complete |
$1,206.67
|
| Rate for Payer: Cash Price |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,111.68
|
| Rate for Payer: Cofinity Commercial |
$2,594.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,111.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,413.34
|
| Rate for Payer: Healthscope Commercial |
$2,715.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,111.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,262.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.18
|
| Rate for Payer: PHP Commercial |
$2,564.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.84
|
| Rate for Payer: Priority Health SBD |
$1,900.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,116.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,262.51
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.56 |
| Max. Negotiated Rate |
$1,803.19 |
| Rate for Payer: Aetna American Axle |
$1,302.30
|
| Rate for Payer: Aetna Commercial |
$1,703.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,402.48
|
| Rate for Payer: Cofinity Commercial |
$1,723.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Healthscope Commercial |
$1,803.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,402.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,502.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: PHP Commercial |
$1,703.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: Priority Health SBD |
$1,262.23
|
| Rate for Payer: UMR Bronson Commercial |
$881.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,502.65
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$2,003.54
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$741.31 |
| Max. Negotiated Rate |
$1,803.19 |
| Rate for Payer: Aetna American Axle |
$1,302.30
|
| Rate for Payer: Aetna Commercial |
$1,703.01
|
| Rate for Payer: Aetna Medicare |
$1,001.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.30
|
| Rate for Payer: BCBS Complete |
$801.42
|
| Rate for Payer: Cash Price |
$1,602.83
|
| Rate for Payer: Cofinity Commercial |
$1,402.48
|
| Rate for Payer: Cofinity Commercial |
$1,723.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,602.83
|
| Rate for Payer: Healthscope Commercial |
$1,803.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,402.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,502.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.01
|
| Rate for Payer: PHP Commercial |
$1,703.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.30
|
| Rate for Payer: Priority Health SBD |
$1,262.23
|
| Rate for Payer: UMR Bronson Commercial |
$741.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,502.65
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna American Axle |
$31.16
|
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: UMR Bronson Commercial |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna American Axle |
$31.16
|
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna American Axle |
$23.50
|
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$18.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.50
|
| Rate for Payer: BCBS Complete |
$14.46
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$31.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: UMR Bronson Commercial |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna American Axle |
$23.50
|
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.50
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$31.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health SBD |
$22.77
|
| Rate for Payer: UMR Bronson Commercial |
$15.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.91 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna American Axle |
$95.89
|
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.89
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health SBD |
$92.94
|
| Rate for Payer: UMR Bronson Commercial |
$64.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.58 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna American Axle |
$95.89
|
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna Medicare |
$73.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.89
|
| Rate for Payer: BCBS Complete |
$59.01
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health SBD |
$92.94
|
| Rate for Payer: UMR Bronson Commercial |
$54.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna American Axle |
$220.46
|
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Medicare |
$169.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.46
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health SBD |
$213.68
|
| Rate for Payer: UMR Bronson Commercial |
$125.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.38
|
|
