|
HC BRACE JEWETT/CASH
|
Facility
|
IP
|
$957.96
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
27400003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$862.16 |
| Rate for Payer: Aetna American Axle |
$622.67
|
| Rate for Payer: Aetna Commercial |
$814.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.67
|
| Rate for Payer: Cash Price |
$766.37
|
| Rate for Payer: Cofinity Commercial |
$670.57
|
| Rate for Payer: Cofinity Commercial |
$823.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.37
|
| Rate for Payer: Healthscope Commercial |
$862.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.27
|
| Rate for Payer: PHP Commercial |
$814.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.67
|
| Rate for Payer: Priority Health SBD |
$603.51
|
| Rate for Payer: UMR Bronson Commercial |
$421.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.47
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
IP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,187.25 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna American Axle |
$3,231.16
|
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.16
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$3,479.71
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,479.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health SBD |
$3,131.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,187.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE KAFO CUSTOM
|
Facility
|
OP
|
$4,971.02
|
|
| Hospital Charge Code |
27000033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,839.28 |
| Max. Negotiated Rate |
$4,473.92 |
| Rate for Payer: Aetna American Axle |
$3,231.16
|
| Rate for Payer: Aetna Commercial |
$4,225.37
|
| Rate for Payer: Aetna Medicare |
$2,485.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.16
|
| Rate for Payer: BCBS Complete |
$1,988.41
|
| Rate for Payer: Cash Price |
$3,976.82
|
| Rate for Payer: Cofinity Commercial |
$3,479.71
|
| Rate for Payer: Cofinity Commercial |
$4,275.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.82
|
| Rate for Payer: Healthscope Commercial |
$4,473.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,479.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,728.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,225.37
|
| Rate for Payer: PHP Commercial |
$4,225.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.16
|
| Rate for Payer: Priority Health SBD |
$3,131.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,839.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,728.26
|
|
|
HC BRACE 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 CUSTOM
|
Facility
|
OP
|
$1,385.37
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
27400004
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$512.59 |
| Max. Negotiated Rate |
$2,144.80 |
| Rate for Payer: Aetna American Axle |
$900.49
|
| Rate for Payer: Aetna Commercial |
$1,177.56
|
| Rate for Payer: Aetna Medicare |
$692.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.49
|
| Rate for Payer: BCBS Complete |
$554.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,144.80
|
| Rate for Payer: BCN Commercial |
$2,144.80
|
| Rate for Payer: Cash Price |
$1,108.30
|
| 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 HMO/PPO/Tiered Network |
$829.91
|
| Rate for Payer: Priority Health Narrow Network |
$663.93
|
| Rate for Payer: Priority Health SBD |
$872.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$972.55
|
| Rate for Payer: UHC Exchange |
$810.46
|
| Rate for Payer: UMR Bronson Commercial |
$512.59
|
| 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 |
$1,222.40
|
| 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 |
$1,222.40
|
|
|
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 |
$396.98 |
| 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: BCBS Trust/PPO |
$1,274.98
|
| Rate for Payer: BCN Commercial |
$1,274.98
|
| Rate for Payer: Cash Price |
$1,303.89
|
| 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 |
$1,222.40
|
| 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 HMO/PPO/Tiered Network |
$496.23
|
| Rate for Payer: Priority Health Narrow Network |
$396.98
|
| Rate for Payer: Priority Health SBD |
$1,026.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.82
|
| Rate for Payer: UHC Exchange |
$668.18
|
| Rate for Payer: UMR Bronson Commercial |
$603.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.40
|
|
|
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 KNEE IMMOBILIZER
|
Facility
|
OP
|
$202.83
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
27400008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.11 |
| Max. Negotiated Rate |
$182.55 |
| Rate for Payer: PHP Commercial |
$172.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.89
|
| Rate for Payer: Priority Health Narrow Network |
$55.11
|
| Rate for Payer: Priority Health SBD |
$127.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.53
|
| Rate for Payer: UHC Exchange |
$85.44
|
| Rate for Payer: UMR Bronson Commercial |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.12
|
| 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: BCBS Trust/PPO |
$176.99
|
| Rate for Payer: BCN Commercial |
$176.99
|
| Rate for Payer: Cash Price |
$162.26
|
| 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
|
|
|
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 |
$488.84
|
| 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 |
$488.84
|
|
|
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 |
$1,279.85 |
| 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: BCBS Trust/PPO |
$1,279.85
|
| Rate for Payer: BCN Commercial |
$1,279.85
|
| Rate for Payer: Cash Price |
$521.42
|
| 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 |
$488.84
|
| 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 HMO/PPO/Tiered Network |
$495.23
|
| Rate for Payer: Priority Health Narrow Network |
$396.18
|
| 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 |
$488.84
|
|
|
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 |
$242.70 |
| 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: BCBS Trust/PPO |
$242.70
|
| Rate for Payer: BCN Commercial |
$242.70
|
| Rate for Payer: Cash Price |
$148.51
|
| 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 HMO/PPO/Tiered Network |
$93.91
|
| Rate for Payer: Priority Health Narrow Network |
$75.13
|
| Rate for Payer: Priority Health SBD |
$116.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.05
|
| Rate for Payer: UHC Exchange |
$91.71
|
| 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 |
$40.04 |
| 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: BCBS Trust/PPO |
$128.59
|
| Rate for Payer: BCN Commercial |
$128.59
|
| Rate for Payer: Cash Price |
$155.94
|
| 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 HMO/PPO/Tiered Network |
$50.05
|
| Rate for Payer: Priority Health Narrow Network |
$40.04
|
| Rate for Payer: Priority Health SBD |
$122.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.38
|
| Rate for Payer: UHC Exchange |
$74.48
|
| 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 |
$4,033.99 |
| 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: BCBS Trust/PPO |
$4,033.99
|
| Rate for Payer: BCN Commercial |
$4,033.99
|
| Rate for Payer: Cash Price |
$2,175.42
|
| 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 HMO/PPO/Tiered Network |
$1,560.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.73
|
| Rate for Payer: Priority Health SBD |
$1,713.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,829.20
|
| Rate for Payer: UHC Exchange |
$1,524.33
|
| 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 |
$489.24 |
| Rate for Payer: Aetna American Axle |
$241.68
|
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: Aetna Medicare |
$185.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.68
|
| Rate for Payer: BCBS Complete |
$148.72
|
| Rate for Payer: BCBS Trust/PPO |
$489.24
|
| Rate for Payer: BCN Commercial |
$489.24
|
| Rate for Payer: Cash Price |
$297.45
|
| 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 HMO/PPO/Tiered Network |
$189.31
|
| Rate for Payer: Priority Health Narrow Network |
$151.45
|
| Rate for Payer: Priority Health SBD |
$234.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.84
|
| Rate for Payer: UHC Exchange |
$184.87
|
| 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: Healthscope Commercial |
$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: 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: Healthscope Commercial |
$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: 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 |
$522.53 |
| 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: BCBS Trust/PPO |
$522.53
|
| Rate for Payer: BCN Commercial |
$522.53
|
| Rate for Payer: Cash Price |
$317.67
|
| 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 HMO/PPO/Tiered Network |
$202.19
|
| Rate for Payer: Priority Health Narrow Network |
$161.75
|
| Rate for Payer: Priority Health SBD |
$250.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.94
|
| Rate for Payer: UHC Exchange |
$197.45
|
| Rate for Payer: UMR Bronson Commercial |
$146.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
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 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 |
$522.53 |
| Rate for Payer: Cash Price |
$349.43
|
| 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: 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: BCBS Trust/PPO |
$522.53
|
| Rate for Payer: BCN Commercial |
$522.53
|
| 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 HMO/PPO/Tiered Network |
$202.19
|
| Rate for Payer: Priority Health Narrow Network |
$161.75
|
| 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
|
|
