Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BRACE HIP ABDUCTION

Facility

$1,811.44

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$724.58
Max. Negotiated Rate	$1,811.44
Rate for Payer: Aetna Commercial	$1,630.30
Rate for Payer: ASR ASR	$1,757.10
Rate for Payer: BCBS Complete	$724.58
Rate for Payer: BCBS Trust/PPO	$1,404.41
Rate for Payer: BCN Commercial	$1,404.41
Rate for Payer: Cash Price	$1,449.15
Rate for Payer: Cofinity Commercial	$1,702.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,449.15
Rate for Payer: Healthscope Commercial	$1,811.44
Rate for Payer: Healthscope Whirlpool	$1,757.10
Rate for Payer: Mclaren Commercial	$1,630.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.72
Rate for Payer: Priority Health Cigna Priority Health	$1,268.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,648.41
Rate for Payer: Priority Health Narrow Network	$1,286.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,594.07

HC BRACE HIP ABDUCTION

Facility

$1,811.44

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$1,268.01
Max. Negotiated Rate	$1,811.44
Rate for Payer: Aetna Commercial	$1,630.30
Rate for Payer: ASR ASR	$1,757.10
Rate for Payer: BCBS Trust/PPO	$1,404.41
Rate for Payer: BCN Commercial	$1,404.41
Rate for Payer: Cash Price	$1,449.15
Rate for Payer: Cofinity Commercial	$1,702.75
Rate for Payer: Encore Health Key Benefits Commercial	$1,449.15
Rate for Payer: Healthscope Commercial	$1,811.44
Rate for Payer: Healthscope Whirlpool	$1,757.10
Rate for Payer: Mclaren Commercial	$1,630.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.72
Rate for Payer: Priority Health Cigna Priority Health	$1,268.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,594.07

HC BRACE HUMERAL SLEEVE

Facility

$816.74

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$326.70
Max. Negotiated Rate	$816.74
Rate for Payer: Aetna Commercial	$735.07
Rate for Payer: ASR ASR	$792.24
Rate for Payer: BCBS Complete	$326.70
Rate for Payer: BCBS Trust/PPO	$633.22
Rate for Payer: BCN Commercial	$633.22
Rate for Payer: Cash Price	$653.39
Rate for Payer: Cofinity Commercial	$767.74
Rate for Payer: Encore Health Key Benefits Commercial	$653.39
Rate for Payer: Healthscope Commercial	$816.74
Rate for Payer: Healthscope Whirlpool	$792.24
Rate for Payer: Mclaren Commercial	$735.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$694.23
Rate for Payer: Priority Health Cigna Priority Health	$571.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$743.23
Rate for Payer: Priority Health Narrow Network	$579.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$718.73

HC BRACE HUMERAL SLEEVE

Facility

$816.74

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$571.72
Max. Negotiated Rate	$816.74
Rate for Payer: Aetna Commercial	$735.07
Rate for Payer: ASR ASR	$792.24
Rate for Payer: BCBS Trust/PPO	$633.22
Rate for Payer: BCN Commercial	$633.22
Rate for Payer: Cash Price	$653.39
Rate for Payer: Cofinity Commercial	$767.74
Rate for Payer: Encore Health Key Benefits Commercial	$653.39
Rate for Payer: Healthscope Commercial	$816.74
Rate for Payer: Healthscope Whirlpool	$792.24
Rate for Payer: Mclaren Commercial	$735.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$694.23
Rate for Payer: Priority Health Cigna Priority Health	$571.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$718.73

HC BRACE JEWETT/CASH

Facility

$939.18

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$657.43
Max. Negotiated Rate	$939.18
Rate for Payer: Aetna Commercial	$845.26
Rate for Payer: ASR ASR	$911.00
Rate for Payer: BCBS Trust/PPO	$728.15
Rate for Payer: BCN Commercial	$728.15
Rate for Payer: Cash Price	$751.34
Rate for Payer: Cofinity Commercial	$882.83
Rate for Payer: Encore Health Key Benefits Commercial	$751.34
Rate for Payer: Healthscope Commercial	$939.18
Rate for Payer: Healthscope Whirlpool	$911.00
Rate for Payer: Mclaren Commercial	$845.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.30
Rate for Payer: Priority Health Cigna Priority Health	$657.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$826.48

HC BRACE JEWETT/CASH

Facility

$939.18

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$375.67
Max. Negotiated Rate	$939.18
Rate for Payer: Aetna Commercial	$845.26
Rate for Payer: ASR ASR	$911.00
Rate for Payer: BCBS Complete	$375.67
Rate for Payer: BCBS Trust/PPO	$728.15
Rate for Payer: BCN Commercial	$728.15
Rate for Payer: Cash Price	$751.34
Rate for Payer: Cofinity Commercial	$882.83
Rate for Payer: Encore Health Key Benefits Commercial	$751.34
Rate for Payer: Healthscope Commercial	$939.18
Rate for Payer: Healthscope Whirlpool	$911.00
Rate for Payer: Mclaren Commercial	$845.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.30
Rate for Payer: Priority Health Cigna Priority Health	$657.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$854.65
Rate for Payer: Priority Health Narrow Network	$666.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$826.48

HC BRACE KAFO CUSTOM

Facility

$4,873.55

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$1,949.42
Max. Negotiated Rate	$4,873.55
Rate for Payer: Aetna Commercial	$4,386.20
Rate for Payer: ASR ASR	$4,727.34
Rate for Payer: BCBS Complete	$1,949.42
Rate for Payer: BCBS Trust/PPO	$3,778.46
Rate for Payer: BCN Commercial	$3,778.46
Rate for Payer: Cash Price	$3,898.84
Rate for Payer: Cofinity Commercial	$4,581.14
Rate for Payer: Encore Health Key Benefits Commercial	$3,898.84
Rate for Payer: Healthscope Commercial	$4,873.55
Rate for Payer: Healthscope Whirlpool	$4,727.34
Rate for Payer: Mclaren Commercial	$4,386.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,142.52
Rate for Payer: Priority Health Cigna Priority Health	$3,411.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,434.93
Rate for Payer: Priority Health Narrow Network	$3,460.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,288.72

HC BRACE KAFO CUSTOM

Facility

$4,873.55

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$3,411.48
Max. Negotiated Rate	$4,873.55
Rate for Payer: Aetna Commercial	$4,386.20
Rate for Payer: ASR ASR	$4,727.34
Rate for Payer: BCBS Trust/PPO	$3,778.46
Rate for Payer: BCN Commercial	$3,778.46
Rate for Payer: Cash Price	$3,898.84
Rate for Payer: Cofinity Commercial	$4,581.14
Rate for Payer: Encore Health Key Benefits Commercial	$3,898.84
Rate for Payer: Healthscope Commercial	$4,873.55
Rate for Payer: Healthscope Whirlpool	$4,727.34
Rate for Payer: Mclaren Commercial	$4,386.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,142.52
Rate for Payer: Priority Health Cigna Priority Health	$3,411.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,288.72

HC BRACE KNEE HINGED CUSTOM

Facility

$1,358.21

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$543.28
Max. Negotiated Rate	$1,358.21
Rate for Payer: Aetna Commercial	$1,222.39
Rate for Payer: ASR ASR	$1,317.46
Rate for Payer: BCBS Complete	$543.28
Rate for Payer: BCBS Trust/PPO	$1,053.02
Rate for Payer: BCN Commercial	$1,053.02
Rate for Payer: Cash Price	$1,086.57
Rate for Payer: Cofinity Commercial	$1,276.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,086.57
Rate for Payer: Healthscope Commercial	$1,358.21
Rate for Payer: Healthscope Whirlpool	$1,317.46
Rate for Payer: Mclaren Commercial	$1,222.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,154.48
Rate for Payer: Priority Health Cigna Priority Health	$950.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,235.97
Rate for Payer: Priority Health Narrow Network	$964.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,195.22

HC BRACE KNEE HINGED CUSTOM

Facility

$1,358.21

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$950.75
Max. Negotiated Rate	$1,358.21
Rate for Payer: Aetna Commercial	$1,222.39
Rate for Payer: ASR ASR	$1,317.46
Rate for Payer: BCBS Trust/PPO	$1,053.02
Rate for Payer: BCN Commercial	$1,053.02
Rate for Payer: Cash Price	$1,086.57
Rate for Payer: Cofinity Commercial	$1,276.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,086.57
Rate for Payer: Healthscope Commercial	$1,358.21
Rate for Payer: Healthscope Whirlpool	$1,317.46
Rate for Payer: Mclaren Commercial	$1,222.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,154.48
Rate for Payer: Priority Health Cigna Priority Health	$950.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,195.22

HC BRACE KNEE HINGED OTS

Facility

$1,597.90

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$1,118.53
Max. Negotiated Rate	$1,597.90
Rate for Payer: Aetna Commercial	$1,438.11
Rate for Payer: ASR ASR	$1,549.96
Rate for Payer: BCBS Trust/PPO	$1,238.85
Rate for Payer: BCN Commercial	$1,238.85
Rate for Payer: Cash Price	$1,278.32
Rate for Payer: Cofinity Commercial	$1,502.03
Rate for Payer: Encore Health Key Benefits Commercial	$1,278.32
Rate for Payer: Healthscope Commercial	$1,597.90
Rate for Payer: Healthscope Whirlpool	$1,549.96
Rate for Payer: Mclaren Commercial	$1,438.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,358.22
Rate for Payer: Priority Health Cigna Priority Health	$1,118.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,406.15

HC BRACE KNEE HINGED OTS

Facility

$1,597.90

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$639.16
Max. Negotiated Rate	$1,597.90
Rate for Payer: Aetna Commercial	$1,438.11
Rate for Payer: ASR ASR	$1,549.96
Rate for Payer: BCBS Complete	$639.16
Rate for Payer: BCBS Trust/PPO	$1,238.85
Rate for Payer: BCN Commercial	$1,238.85
Rate for Payer: Cash Price	$1,278.32
Rate for Payer: Cofinity Commercial	$1,502.03
Rate for Payer: Encore Health Key Benefits Commercial	$1,278.32
Rate for Payer: Healthscope Commercial	$1,597.90
Rate for Payer: Healthscope Whirlpool	$1,549.96
Rate for Payer: Mclaren Commercial	$1,438.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,358.22
Rate for Payer: Priority Health Cigna Priority Health	$1,118.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,454.09
Rate for Payer: Priority Health Narrow Network	$1,134.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,406.15

HC BRACE KNEE IMMOBILIZER

Facility

$198.85

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$139.20
Max. Negotiated Rate	$198.85
Rate for Payer: Aetna Commercial	$178.96
Rate for Payer: ASR ASR	$192.88
Rate for Payer: BCBS Trust/PPO	$154.17
Rate for Payer: BCN Commercial	$154.17
Rate for Payer: Cash Price	$159.08
Rate for Payer: Cofinity Commercial	$186.92
Rate for Payer: Encore Health Key Benefits Commercial	$159.08
Rate for Payer: Healthscope Commercial	$198.85
Rate for Payer: Healthscope Whirlpool	$192.88
Rate for Payer: Mclaren Commercial	$178.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.02
Rate for Payer: Priority Health Cigna Priority Health	$139.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.99

HC BRACE KNEE IMMOBILIZER

Facility

$198.85

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$198.85
Rate for Payer: Aetna Commercial	$178.96
Rate for Payer: ASR ASR	$192.88
Rate for Payer: BCBS Complete	$79.54
Rate for Payer: BCBS Trust/PPO	$154.17
Rate for Payer: BCN Commercial	$154.17
Rate for Payer: Cash Price	$159.08
Rate for Payer: Cofinity Commercial	$186.92
Rate for Payer: Encore Health Key Benefits Commercial	$159.08
Rate for Payer: Healthscope Commercial	$198.85
Rate for Payer: Healthscope Whirlpool	$192.88
Rate for Payer: Mclaren Commercial	$178.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.02
Rate for Payer: Priority Health Cigna Priority Health	$139.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.95
Rate for Payer: Priority Health Narrow Network	$141.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.99

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$639.00

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$639.00
Rate for Payer: Aetna Commercial	$575.10
Rate for Payer: ASR ASR	$619.83
Rate for Payer: BCBS Trust/PPO	$495.42
Rate for Payer: BCN Commercial	$495.42
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$600.66
Rate for Payer: Encore Health Key Benefits Commercial	$511.20
Rate for Payer: Healthscope Commercial	$639.00
Rate for Payer: Healthscope Whirlpool	$619.83
Rate for Payer: Mclaren Commercial	$575.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.15
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$562.32

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$639.00

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$639.00
Rate for Payer: Aetna Commercial	$575.10
Rate for Payer: ASR ASR	$619.83
Rate for Payer: BCBS Complete	$255.60
Rate for Payer: BCBS Trust/PPO	$495.42
Rate for Payer: BCN Commercial	$495.42
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$600.66
Rate for Payer: Encore Health Key Benefits Commercial	$511.20
Rate for Payer: Healthscope Commercial	$639.00
Rate for Payer: Healthscope Whirlpool	$619.83
Rate for Payer: Mclaren Commercial	$575.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.15
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$581.49
Rate for Payer: Priority Health Narrow Network	$453.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$562.32

HC BRACE LS CORSET CUSTOM

Facility

$182.00

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: ASR ASR	$176.54
Rate for Payer: BCBS Complete	$72.80
Rate for Payer: BCBS Trust/PPO	$141.10
Rate for Payer: BCN Commercial	$141.10
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Encore Health Key Benefits Commercial	$145.60
Rate for Payer: Healthscope Commercial	$182.00
Rate for Payer: Healthscope Whirlpool	$176.54
Rate for Payer: Mclaren Commercial	$163.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.70
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.62
Rate for Payer: Priority Health Narrow Network	$129.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$160.16

HC BRACE LS CORSET CUSTOM

Facility

$182.00

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: ASR ASR	$176.54
Rate for Payer: BCBS Trust/PPO	$141.10
Rate for Payer: BCN Commercial	$141.10
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Encore Health Key Benefits Commercial	$145.60
Rate for Payer: Healthscope Commercial	$182.00
Rate for Payer: Healthscope Whirlpool	$176.54
Rate for Payer: Mclaren Commercial	$163.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.70
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$160.16

HC BRACE LS CORSET OTS

Facility

$191.10

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$191.10
Rate for Payer: Aetna Commercial	$171.99
Rate for Payer: ASR ASR	$185.37
Rate for Payer: BCBS Complete	$76.44
Rate for Payer: BCBS Trust/PPO	$148.16
Rate for Payer: BCN Commercial	$148.16
Rate for Payer: Cash Price	$152.88
Rate for Payer: Cofinity Commercial	$179.63
Rate for Payer: Encore Health Key Benefits Commercial	$152.88
Rate for Payer: Healthscope Commercial	$191.10
Rate for Payer: Healthscope Whirlpool	$185.37
Rate for Payer: Mclaren Commercial	$171.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.44
Rate for Payer: Priority Health Cigna Priority Health	$133.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.90
Rate for Payer: Priority Health Narrow Network	$135.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$168.17

HC BRACE LS CORSET OTS

Facility

$191.10

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$133.77
Max. Negotiated Rate	$191.10
Rate for Payer: Aetna Commercial	$171.99
Rate for Payer: ASR ASR	$185.37
Rate for Payer: BCBS Trust/PPO	$148.16
Rate for Payer: BCN Commercial	$148.16
Rate for Payer: Cash Price	$152.88
Rate for Payer: Cofinity Commercial	$179.63
Rate for Payer: Encore Health Key Benefits Commercial	$152.88
Rate for Payer: Healthscope Commercial	$191.10
Rate for Payer: Healthscope Whirlpool	$185.37
Rate for Payer: Mclaren Commercial	$171.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.44
Rate for Payer: Priority Health Cigna Priority Health	$133.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$168.17

HC BRACE LSO CUSTOM

Facility

$2,504.42

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,001.77
Max. Negotiated Rate	$2,504.42
Rate for Payer: Aetna Commercial	$2,253.98
Rate for Payer: ASR ASR	$2,429.29
Rate for Payer: BCBS Complete	$1,001.77
Rate for Payer: BCBS Trust/PPO	$1,941.68
Rate for Payer: BCN Commercial	$1,941.68
Rate for Payer: Cash Price	$2,003.54
Rate for Payer: Cofinity Commercial	$2,354.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,003.54
Rate for Payer: Healthscope Commercial	$2,504.42
Rate for Payer: Healthscope Whirlpool	$2,429.29
Rate for Payer: Mclaren Commercial	$2,253.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,128.76
Rate for Payer: Priority Health Cigna Priority Health	$1,753.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,279.02
Rate for Payer: Priority Health Narrow Network	$1,778.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,203.89

HC BRACE LSO CUSTOM

Facility

$2,504.42

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,753.09
Max. Negotiated Rate	$2,504.42
Rate for Payer: Aetna Commercial	$2,253.98
Rate for Payer: ASR ASR	$2,429.29
Rate for Payer: BCBS Trust/PPO	$1,941.68
Rate for Payer: BCN Commercial	$1,941.68
Rate for Payer: Cash Price	$2,003.54
Rate for Payer: Cofinity Commercial	$2,354.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,003.54
Rate for Payer: Healthscope Commercial	$2,504.42
Rate for Payer: Healthscope Whirlpool	$2,429.29
Rate for Payer: Mclaren Commercial	$2,253.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,128.76
Rate for Payer: Priority Health Cigna Priority Health	$1,753.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,203.89

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,665.96

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,066.38
Max. Negotiated Rate	$2,665.96
Rate for Payer: Aetna Commercial	$2,399.36
Rate for Payer: ASR ASR	$2,585.98
Rate for Payer: BCBS Complete	$1,066.38
Rate for Payer: BCBS Trust/PPO	$2,066.92
Rate for Payer: BCN Commercial	$2,066.92
Rate for Payer: Cash Price	$2,132.77
Rate for Payer: Cofinity Commercial	$2,506.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,132.77
Rate for Payer: Healthscope Commercial	$2,665.96
Rate for Payer: Healthscope Whirlpool	$2,585.98
Rate for Payer: Mclaren Commercial	$2,399.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,266.07
Rate for Payer: Priority Health Cigna Priority Health	$1,866.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,426.02
Rate for Payer: Priority Health Narrow Network	$1,892.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,346.04

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,665.96

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,866.17
Max. Negotiated Rate	$2,665.96
Rate for Payer: Aetna Commercial	$2,399.36
Rate for Payer: ASR ASR	$2,585.98
Rate for Payer: BCBS Trust/PPO	$2,066.92
Rate for Payer: BCN Commercial	$2,066.92
Rate for Payer: Cash Price	$2,132.77
Rate for Payer: Cofinity Commercial	$2,506.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,132.77
Rate for Payer: Healthscope Commercial	$2,665.96
Rate for Payer: Healthscope Whirlpool	$2,585.98
Rate for Payer: Mclaren Commercial	$2,399.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,266.07
Rate for Payer: Priority Health Cigna Priority Health	$1,866.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,346.04

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$364.52

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$145.81
Max. Negotiated Rate	$364.52
Rate for Payer: Aetna Commercial	$328.07
Rate for Payer: ASR ASR	$353.58
Rate for Payer: BCBS Complete	$145.81
Rate for Payer: BCBS Trust/PPO	$282.61
Rate for Payer: BCN Commercial	$282.61
Rate for Payer: Cash Price	$291.62
Rate for Payer: Cofinity Commercial	$342.65
Rate for Payer: Encore Health Key Benefits Commercial	$291.62
Rate for Payer: Healthscope Commercial	$364.52
Rate for Payer: Healthscope Whirlpool	$353.58
Rate for Payer: Mclaren Commercial	$328.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$309.84
Rate for Payer: Priority Health Cigna Priority Health	$255.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$331.71
Rate for Payer: Priority Health Narrow Network	$258.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$320.78

Know your out-of-pocket cost for care.

All Charges