Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BRACE KNEE HINGED OTS

Facility

$1,662.46

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$1,246.85
Max. Negotiated Rate	$1,662.46
Rate for Payer: Aetna Commercial	$1,496.21
Rate for Payer: ASR ASR	$1,612.59
Rate for Payer: BCBS Trust/PPO	$1,365.21
Rate for Payer: BCN Commercial	$1,365.21
Rate for Payer: Cash Price	$1,329.97
Rate for Payer: Cofinity Commercial	$1,562.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,329.97
Rate for Payer: Healthscope Commercial	$1,612.59
Rate for Payer: Healthscope Whirlpool	$1,662.46
Rate for Payer: Mclaren Commercial	$1,496.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,413.09
Rate for Payer: Nomi Health Commercial	$1,363.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,462.96

HC BRACE KNEE HINGED OTS

Facility

$1,662.46

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$615.11
Max. Negotiated Rate	$1,662.46
Rate for Payer: Aetna Commercial	$1,496.21
Rate for Payer: Aetna Medicare	$615.11
Rate for Payer: ASR ASR	$1,612.59
Rate for Payer: BCBS Complete	$664.98
Rate for Payer: BCBS Trust/PPO	$1,370.70
Rate for Payer: BCN Commercial	$1,370.70
Rate for Payer: Cash Price	$1,329.97
Rate for Payer: Cofinity Commercial	$1,562.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,329.97
Rate for Payer: Healthscope Commercial	$1,612.59
Rate for Payer: Healthscope Whirlpool	$1,662.46
Rate for Payer: Mclaren Commercial	$1,496.21
Rate for Payer: MI Amish Medical Board Commercial	$1,329.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,413.09
Rate for Payer: Nomi Health Commercial	$1,363.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,456.65
Rate for Payer: Priority Health Narrow Network	$1,165.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,462.96

HC BRACE KNEE IMMOBILIZER

Facility

$206.89

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$155.17
Max. Negotiated Rate	$206.89
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: ASR ASR	$200.68
Rate for Payer: BCBS Trust/PPO	$169.90
Rate for Payer: BCN Commercial	$169.90
Rate for Payer: Cash Price	$165.51
Rate for Payer: Cofinity Commercial	$194.48
Rate for Payer: Encore Health Key Benefits Commercial	$165.51
Rate for Payer: Healthscope Commercial	$200.68
Rate for Payer: Healthscope Whirlpool	$206.89
Rate for Payer: Mclaren Commercial	$186.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.86
Rate for Payer: Nomi Health Commercial	$169.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$182.06

HC BRACE KNEE IMMOBILIZER

Facility

$206.89

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$76.55
Max. Negotiated Rate	$206.89
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare	$76.55
Rate for Payer: ASR ASR	$200.68
Rate for Payer: BCBS Complete	$82.76
Rate for Payer: BCBS Trust/PPO	$170.58
Rate for Payer: BCN Commercial	$170.58
Rate for Payer: Cash Price	$165.51
Rate for Payer: Cofinity Commercial	$194.48
Rate for Payer: Encore Health Key Benefits Commercial	$165.51
Rate for Payer: Healthscope Commercial	$200.68
Rate for Payer: Healthscope Whirlpool	$206.89
Rate for Payer: Mclaren Commercial	$186.20
Rate for Payer: MI Amish Medical Board Commercial	$165.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.86
Rate for Payer: Nomi Health Commercial	$169.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$181.28
Rate for Payer: Priority Health Narrow Network	$145.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$182.06

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

Facility

$664.82

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$245.98
Max. Negotiated Rate	$664.82
Rate for Payer: Aetna Commercial	$598.34
Rate for Payer: Aetna Medicare	$245.98
Rate for Payer: ASR ASR	$644.88
Rate for Payer: BCBS Complete	$265.93
Rate for Payer: BCBS Trust/PPO	$548.14
Rate for Payer: BCN Commercial	$548.14
Rate for Payer: Cash Price	$531.86
Rate for Payer: Cofinity Commercial	$624.93
Rate for Payer: Encore Health Key Benefits Commercial	$531.86
Rate for Payer: Healthscope Commercial	$644.88
Rate for Payer: Healthscope Whirlpool	$664.82
Rate for Payer: Mclaren Commercial	$598.34
Rate for Payer: MI Amish Medical Board Commercial	$531.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$565.10
Rate for Payer: Nomi Health Commercial	$545.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$498.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$582.52
Rate for Payer: Priority Health Narrow Network	$466.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$585.04

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

Facility

$664.82

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$498.62
Max. Negotiated Rate	$664.82
Rate for Payer: Aetna Commercial	$598.34
Rate for Payer: ASR ASR	$644.88
Rate for Payer: BCBS Trust/PPO	$545.95
Rate for Payer: BCN Commercial	$545.95
Rate for Payer: Cash Price	$531.86
Rate for Payer: Cofinity Commercial	$624.93
Rate for Payer: Encore Health Key Benefits Commercial	$531.86
Rate for Payer: Healthscope Commercial	$644.88
Rate for Payer: Healthscope Whirlpool	$664.82
Rate for Payer: Mclaren Commercial	$598.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$565.10
Rate for Payer: Nomi Health Commercial	$545.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$498.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$585.04

HC BRACE LS CORSET CUSTOM

Facility

$189.35

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$70.06
Max. Negotiated Rate	$189.35
Rate for Payer: Aetna Commercial	$170.41
Rate for Payer: Aetna Medicare	$70.06
Rate for Payer: ASR ASR	$183.67
Rate for Payer: BCBS Complete	$75.74
Rate for Payer: BCBS Trust/PPO	$156.12
Rate for Payer: BCN Commercial	$156.12
Rate for Payer: Cash Price	$151.48
Rate for Payer: Cofinity Commercial	$177.99
Rate for Payer: Encore Health Key Benefits Commercial	$151.48
Rate for Payer: Healthscope Commercial	$183.67
Rate for Payer: Healthscope Whirlpool	$189.35
Rate for Payer: Mclaren Commercial	$170.41
Rate for Payer: MI Amish Medical Board Commercial	$151.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.95
Rate for Payer: Nomi Health Commercial	$155.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$165.91
Rate for Payer: Priority Health Narrow Network	$132.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$166.63

HC BRACE LS CORSET CUSTOM

Facility

$189.35

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$142.01
Max. Negotiated Rate	$189.35
Rate for Payer: Aetna Commercial	$170.41
Rate for Payer: ASR ASR	$183.67
Rate for Payer: BCBS Trust/PPO	$155.49
Rate for Payer: BCN Commercial	$155.49
Rate for Payer: Cash Price	$151.48
Rate for Payer: Cofinity Commercial	$177.99
Rate for Payer: Encore Health Key Benefits Commercial	$151.48
Rate for Payer: Healthscope Commercial	$183.67
Rate for Payer: Healthscope Whirlpool	$189.35
Rate for Payer: Mclaren Commercial	$170.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.95
Rate for Payer: Nomi Health Commercial	$155.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$166.63

HC BRACE LS CORSET OTS

Facility

$198.82

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$73.56
Max. Negotiated Rate	$198.82
Rate for Payer: Aetna Commercial	$178.94
Rate for Payer: Aetna Medicare	$73.56
Rate for Payer: ASR ASR	$192.86
Rate for Payer: BCBS Complete	$79.53
Rate for Payer: BCBS Trust/PPO	$163.93
Rate for Payer: BCN Commercial	$163.93
Rate for Payer: Cash Price	$159.06
Rate for Payer: Cofinity Commercial	$186.89
Rate for Payer: Encore Health Key Benefits Commercial	$159.06
Rate for Payer: Healthscope Commercial	$192.86
Rate for Payer: Healthscope Whirlpool	$198.82
Rate for Payer: Mclaren Commercial	$178.94
Rate for Payer: MI Amish Medical Board Commercial	$159.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.00
Rate for Payer: Nomi Health Commercial	$163.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$174.21
Rate for Payer: Priority Health Narrow Network	$139.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.96

HC BRACE LS CORSET OTS

Facility

$198.82

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$149.12
Max. Negotiated Rate	$198.82
Rate for Payer: Aetna Commercial	$178.94
Rate for Payer: ASR ASR	$192.86
Rate for Payer: BCBS Trust/PPO	$163.27
Rate for Payer: BCN Commercial	$163.27
Rate for Payer: Cash Price	$159.06
Rate for Payer: Cofinity Commercial	$186.89
Rate for Payer: Encore Health Key Benefits Commercial	$159.06
Rate for Payer: Healthscope Commercial	$192.86
Rate for Payer: Healthscope Whirlpool	$198.82
Rate for Payer: Mclaren Commercial	$178.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.00
Rate for Payer: Nomi Health Commercial	$163.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.96

HC BRACE LSO CUSTOM

Facility

$2,605.60

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$964.07
Max. Negotiated Rate	$2,605.60
Rate for Payer: Aetna Commercial	$2,345.04
Rate for Payer: Aetna Medicare	$964.07
Rate for Payer: ASR ASR	$2,527.43
Rate for Payer: BCBS Complete	$1,042.24
Rate for Payer: BCBS Trust/PPO	$2,148.32
Rate for Payer: BCN Commercial	$2,148.32
Rate for Payer: Cash Price	$2,084.48
Rate for Payer: Cofinity Commercial	$2,449.26
Rate for Payer: Encore Health Key Benefits Commercial	$2,084.48
Rate for Payer: Healthscope Commercial	$2,527.43
Rate for Payer: Healthscope Whirlpool	$2,605.60
Rate for Payer: Mclaren Commercial	$2,345.04
Rate for Payer: MI Amish Medical Board Commercial	$2,084.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,214.76
Rate for Payer: Nomi Health Commercial	$2,136.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,954.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,283.03
Rate for Payer: Priority Health Narrow Network	$1,826.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,292.93

HC BRACE LSO CUSTOM

Facility

$2,605.60

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,954.20
Max. Negotiated Rate	$2,605.60
Rate for Payer: Aetna Commercial	$2,345.04
Rate for Payer: ASR ASR	$2,527.43
Rate for Payer: BCBS Trust/PPO	$2,139.72
Rate for Payer: BCN Commercial	$2,139.72
Rate for Payer: Cash Price	$2,084.48
Rate for Payer: Cofinity Commercial	$2,449.26
Rate for Payer: Encore Health Key Benefits Commercial	$2,084.48
Rate for Payer: Healthscope Commercial	$2,527.43
Rate for Payer: Healthscope Whirlpool	$2,605.60
Rate for Payer: Mclaren Commercial	$2,345.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,214.76
Rate for Payer: Nomi Health Commercial	$2,136.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,954.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,292.93

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,773.67

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,026.26
Max. Negotiated Rate	$2,773.67
Rate for Payer: Aetna Commercial	$2,496.30
Rate for Payer: Aetna Medicare	$1,026.26
Rate for Payer: ASR ASR	$2,690.46
Rate for Payer: BCBS Complete	$1,109.47
Rate for Payer: BCBS Trust/PPO	$2,286.89
Rate for Payer: BCN Commercial	$2,286.89
Rate for Payer: Cash Price	$2,218.94
Rate for Payer: Cofinity Commercial	$2,607.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,218.94
Rate for Payer: Healthscope Commercial	$2,690.46
Rate for Payer: Healthscope Whirlpool	$2,773.67
Rate for Payer: Mclaren Commercial	$2,496.30
Rate for Payer: MI Amish Medical Board Commercial	$2,218.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,357.62
Rate for Payer: Nomi Health Commercial	$2,274.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,080.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,430.29
Rate for Payer: Priority Health Narrow Network	$1,944.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,440.83

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,773.67

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$2,080.25
Max. Negotiated Rate	$2,773.67
Rate for Payer: Aetna Commercial	$2,496.30
Rate for Payer: ASR ASR	$2,690.46
Rate for Payer: BCBS Trust/PPO	$2,277.74
Rate for Payer: BCN Commercial	$2,277.74
Rate for Payer: Cash Price	$2,218.94
Rate for Payer: Cofinity Commercial	$2,607.25
Rate for Payer: Encore Health Key Benefits Commercial	$2,218.94
Rate for Payer: Healthscope Commercial	$2,690.46
Rate for Payer: Healthscope Whirlpool	$2,773.67
Rate for Payer: Mclaren Commercial	$2,496.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,357.62
Rate for Payer: Nomi Health Commercial	$2,274.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,080.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,440.83

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$379.25

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$284.44
Max. Negotiated Rate	$379.25
Rate for Payer: Aetna Commercial	$341.32
Rate for Payer: ASR ASR	$367.87
Rate for Payer: BCBS Trust/PPO	$311.44
Rate for Payer: BCN Commercial	$311.44
Rate for Payer: Cash Price	$303.40
Rate for Payer: Cofinity Commercial	$356.50
Rate for Payer: Encore Health Key Benefits Commercial	$303.40
Rate for Payer: Healthscope Commercial	$367.87
Rate for Payer: Healthscope Whirlpool	$379.25
Rate for Payer: Mclaren Commercial	$341.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.36
Rate for Payer: Nomi Health Commercial	$310.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$284.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$333.74

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$379.25

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$140.32
Max. Negotiated Rate	$379.25
Rate for Payer: Aetna Commercial	$341.32
Rate for Payer: Aetna Medicare	$140.32
Rate for Payer: ASR ASR	$367.87
Rate for Payer: BCBS Complete	$151.70
Rate for Payer: BCBS Trust/PPO	$312.69
Rate for Payer: BCN Commercial	$312.69
Rate for Payer: Cash Price	$303.40
Rate for Payer: Cofinity Commercial	$356.50
Rate for Payer: Encore Health Key Benefits Commercial	$303.40
Rate for Payer: Healthscope Commercial	$367.87
Rate for Payer: Healthscope Whirlpool	$379.25
Rate for Payer: Mclaren Commercial	$341.32
Rate for Payer: MI Amish Medical Board Commercial	$303.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.36
Rate for Payer: Nomi Health Commercial	$310.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$284.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$332.30
Rate for Payer: Priority Health Narrow Network	$265.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$333.74

HC BRACE PRAFO CUSTOM

Facility

$405.03

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$303.77
Max. Negotiated Rate	$405.03
Rate for Payer: Aetna Commercial	$364.53
Rate for Payer: ASR ASR	$392.88
Rate for Payer: BCBS Trust/PPO	$332.61
Rate for Payer: BCN Commercial	$332.61
Rate for Payer: Cash Price	$324.02
Rate for Payer: Cofinity Commercial	$380.73
Rate for Payer: Encore Health Key Benefits Commercial	$324.02
Rate for Payer: Healthscope Commercial	$392.88
Rate for Payer: Healthscope Whirlpool	$405.03
Rate for Payer: Mclaren Commercial	$364.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$344.28
Rate for Payer: Nomi Health Commercial	$332.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$356.43

HC BRACE PRAFO CUSTOM

Facility

$405.03

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$149.86
Max. Negotiated Rate	$405.03
Rate for Payer: Aetna Commercial	$364.53
Rate for Payer: Aetna Medicare	$149.86
Rate for Payer: ASR ASR	$392.88
Rate for Payer: BCBS Complete	$162.01
Rate for Payer: BCBS Trust/PPO	$333.95
Rate for Payer: BCN Commercial	$333.95
Rate for Payer: Cash Price	$324.02
Rate for Payer: Cofinity Commercial	$380.73
Rate for Payer: Encore Health Key Benefits Commercial	$324.02
Rate for Payer: Healthscope Commercial	$392.88
Rate for Payer: Healthscope Whirlpool	$405.03
Rate for Payer: Mclaren Commercial	$364.53
Rate for Payer: MI Amish Medical Board Commercial	$324.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$344.28
Rate for Payer: Nomi Health Commercial	$332.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$354.89
Rate for Payer: Priority Health Narrow Network	$283.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$356.43

HC BRACE PRAFO OTS

Facility

$445.53

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$445.53
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: Aetna Medicare	$164.85
Rate for Payer: ASR ASR	$432.16
Rate for Payer: BCBS Complete	$178.21
Rate for Payer: BCBS Trust/PPO	$367.34
Rate for Payer: BCN Commercial	$367.34
Rate for Payer: Cash Price	$356.42
Rate for Payer: Cofinity Commercial	$418.80
Rate for Payer: Encore Health Key Benefits Commercial	$356.42
Rate for Payer: Healthscope Commercial	$432.16
Rate for Payer: Healthscope Whirlpool	$445.53
Rate for Payer: Mclaren Commercial	$400.98
Rate for Payer: MI Amish Medical Board Commercial	$356.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.70
Rate for Payer: Nomi Health Commercial	$365.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$390.37
Rate for Payer: Priority Health Narrow Network	$312.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$392.07

HC BRACE PRAFO OTS

Facility

$445.53

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$334.15
Max. Negotiated Rate	$445.53
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: ASR ASR	$432.16
Rate for Payer: BCBS Trust/PPO	$365.87
Rate for Payer: BCN Commercial	$365.87
Rate for Payer: Cash Price	$356.42
Rate for Payer: Cofinity Commercial	$418.80
Rate for Payer: Encore Health Key Benefits Commercial	$356.42
Rate for Payer: Healthscope Commercial	$432.16
Rate for Payer: Healthscope Whirlpool	$445.53
Rate for Payer: Mclaren Commercial	$400.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.70
Rate for Payer: Nomi Health Commercial	$365.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$392.07

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$549.22

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$411.92
Max. Negotiated Rate	$549.22
Rate for Payer: Aetna Commercial	$494.30
Rate for Payer: ASR ASR	$532.74
Rate for Payer: BCBS Trust/PPO	$451.02
Rate for Payer: BCN Commercial	$451.02
Rate for Payer: Cash Price	$439.38
Rate for Payer: Cofinity Commercial	$516.27
Rate for Payer: Encore Health Key Benefits Commercial	$439.38
Rate for Payer: Healthscope Commercial	$532.74
Rate for Payer: Healthscope Whirlpool	$549.22
Rate for Payer: Mclaren Commercial	$494.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$466.84
Rate for Payer: Nomi Health Commercial	$450.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$483.31

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$549.22

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$203.21
Max. Negotiated Rate	$549.22
Rate for Payer: Aetna Commercial	$494.30
Rate for Payer: Aetna Medicare	$203.21
Rate for Payer: ASR ASR	$532.74
Rate for Payer: BCBS Complete	$219.69
Rate for Payer: BCBS Trust/PPO	$452.83
Rate for Payer: BCN Commercial	$452.83
Rate for Payer: Cash Price	$439.38
Rate for Payer: Cofinity Commercial	$516.27
Rate for Payer: Encore Health Key Benefits Commercial	$439.38
Rate for Payer: Healthscope Commercial	$532.74
Rate for Payer: Healthscope Whirlpool	$549.22
Rate for Payer: Mclaren Commercial	$494.30
Rate for Payer: MI Amish Medical Board Commercial	$439.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$466.84
Rate for Payer: Nomi Health Commercial	$450.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$481.23
Rate for Payer: Priority Health Narrow Network	$385.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$483.31

HC BRACE RIGID NECK

Facility

$188.76

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$69.84
Max. Negotiated Rate	$188.76
Rate for Payer: Aetna Commercial	$169.88
Rate for Payer: Aetna Medicare	$69.84
Rate for Payer: ASR ASR	$183.10
Rate for Payer: BCBS Complete	$75.50
Rate for Payer: BCBS Trust/PPO	$155.63
Rate for Payer: BCN Commercial	$155.63
Rate for Payer: Cash Price	$151.01
Rate for Payer: Cofinity Commercial	$177.43
Rate for Payer: Encore Health Key Benefits Commercial	$151.01
Rate for Payer: Healthscope Commercial	$183.10
Rate for Payer: Healthscope Whirlpool	$188.76
Rate for Payer: Mclaren Commercial	$169.88
Rate for Payer: MI Amish Medical Board Commercial	$151.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.45
Rate for Payer: Nomi Health Commercial	$154.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$165.39
Rate for Payer: Priority Health Narrow Network	$132.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$166.11

HC BRACE RIGID NECK

Facility

$188.76

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$141.57
Max. Negotiated Rate	$188.76
Rate for Payer: Aetna Commercial	$169.88
Rate for Payer: ASR ASR	$183.10
Rate for Payer: BCBS Trust/PPO	$155.01
Rate for Payer: BCN Commercial	$155.01
Rate for Payer: Cash Price	$151.01
Rate for Payer: Cofinity Commercial	$177.43
Rate for Payer: Encore Health Key Benefits Commercial	$151.01
Rate for Payer: Healthscope Commercial	$183.10
Rate for Payer: Healthscope Whirlpool	$188.76
Rate for Payer: Mclaren Commercial	$169.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.45
Rate for Payer: Nomi Health Commercial	$154.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$166.11

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$548.65

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$548.65
Rate for Payer: Aetna Commercial	$493.79
Rate for Payer: Aetna Medicare	$203.00
Rate for Payer: ASR ASR	$532.19
Rate for Payer: BCBS Complete	$219.46
Rate for Payer: BCBS Trust/PPO	$452.36
Rate for Payer: BCN Commercial	$452.36
Rate for Payer: Cash Price	$438.92
Rate for Payer: Cofinity Commercial	$515.73
Rate for Payer: Encore Health Key Benefits Commercial	$438.92
Rate for Payer: Healthscope Commercial	$532.19
Rate for Payer: Healthscope Whirlpool	$548.65
Rate for Payer: Mclaren Commercial	$493.79
Rate for Payer: MI Amish Medical Board Commercial	$438.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$466.35
Rate for Payer: Nomi Health Commercial	$449.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$480.73
Rate for Payer: Priority Health Narrow Network	$384.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$482.81

Know your out-of-pocket cost for care.

All Charges