Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BRACE AK PELVIC CONTROL BELT LIGHT

Facility

$329.81

Service Code	HCPCS L5692
Hospital Charge Code	27400038
Hospital Revenue Code	274
Min. Negotiated Rate	$131.92
Max. Negotiated Rate	$329.81
Rate for Payer: Aetna Commercial	$296.83
Rate for Payer: Aetna Medicare	$164.90
Rate for Payer: ASR ASR	$319.92
Rate for Payer: ASR Commercial	$319.92
Rate for Payer: BCBS Complete	$131.92
Rate for Payer: BCBS Trust/PPO	$270.08
Rate for Payer: BCN Commercial	$255.70
Rate for Payer: Cash Price	$263.85
Rate for Payer: Cofinity Commercial	$310.02
Rate for Payer: Encore Health Key Benefits Commercial	$263.85
Rate for Payer: Healthscope Commercial	$329.81
Rate for Payer: Healthscope Whirlpool	$319.92
Rate for Payer: Mclaren Commercial	$296.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$280.34
Rate for Payer: Nomi Health Commercial	$270.44
Rate for Payer: Priority Health Cigna Priority Health	$214.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$288.98
Rate for Payer: Priority Health Narrow Network	$231.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$290.23

HC BRACE AK PROSTH SOCK SINGLE-PLY/6

Facility

$132.50

Service Code	HCPCS L8480
Hospital Charge Code	27400034
Hospital Revenue Code	274
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$119.25
Rate for Payer: Aetna Medicare	$66.25
Rate for Payer: ASR ASR	$128.52
Rate for Payer: ASR Commercial	$128.52
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCBS Trust/PPO	$108.50
Rate for Payer: BCN Commercial	$102.73
Rate for Payer: Cash Price	$106.00
Rate for Payer: Cofinity Commercial	$124.55
Rate for Payer: Encore Health Key Benefits Commercial	$106.00
Rate for Payer: Healthscope Commercial	$132.50
Rate for Payer: Healthscope Whirlpool	$128.52
Rate for Payer: Mclaren Commercial	$119.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.62
Rate for Payer: Nomi Health Commercial	$108.65
Rate for Payer: Priority Health Cigna Priority Health	$86.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$116.10
Rate for Payer: Priority Health Narrow Network	$92.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.60

HC BRACE AK PROSTH SOCK SINGLE-PLY/6

Facility

$132.50

Service Code	HCPCS L8480
Hospital Charge Code	27400034
Hospital Revenue Code	274
Min. Negotiated Rate	$86.12
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$119.25
Rate for Payer: ASR ASR	$128.52
Rate for Payer: ASR Commercial	$128.52
Rate for Payer: BCBS Trust/PPO	$107.97
Rate for Payer: BCN Commercial	$102.73
Rate for Payer: Cash Price	$106.00
Rate for Payer: Cofinity Commercial	$124.55
Rate for Payer: Encore Health Key Benefits Commercial	$106.00
Rate for Payer: Healthscope Commercial	$132.50
Rate for Payer: Healthscope Whirlpool	$128.52
Rate for Payer: Mclaren Commercial	$119.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.62
Rate for Payer: Nomi Health Commercial	$108.65
Rate for Payer: Priority Health Cigna Priority Health	$86.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.60

HC BRACE AK RIGID DRESSING NWB

Facility

$1,497.14

Service Code	HCPCS L5460
Hospital Charge Code	27400033
Hospital Revenue Code	274
Min. Negotiated Rate	$973.14
Max. Negotiated Rate	$1,497.14
Rate for Payer: Aetna Commercial	$1,347.43
Rate for Payer: ASR ASR	$1,452.23
Rate for Payer: ASR Commercial	$1,452.23
Rate for Payer: BCBS Trust/PPO	$1,220.02
Rate for Payer: BCN Commercial	$1,160.73
Rate for Payer: Cash Price	$1,197.71
Rate for Payer: Cofinity Commercial	$1,407.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,197.71
Rate for Payer: Healthscope Commercial	$1,497.14
Rate for Payer: Healthscope Whirlpool	$1,452.23
Rate for Payer: Mclaren Commercial	$1,347.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,272.57
Rate for Payer: Nomi Health Commercial	$1,227.65
Rate for Payer: Priority Health Cigna Priority Health	$973.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,317.48

HC BRACE AK RIGID DRESSING NWB

Facility

$1,497.14

Service Code	HCPCS L5460
Hospital Charge Code	27400033
Hospital Revenue Code	274
Min. Negotiated Rate	$598.86
Max. Negotiated Rate	$1,497.14
Rate for Payer: Aetna Commercial	$1,347.43
Rate for Payer: Aetna Medicare	$748.57
Rate for Payer: ASR ASR	$1,452.23
Rate for Payer: ASR Commercial	$1,452.23
Rate for Payer: BCBS Complete	$598.86
Rate for Payer: BCBS Trust/PPO	$1,226.01
Rate for Payer: BCN Commercial	$1,160.73
Rate for Payer: Cash Price	$1,197.71
Rate for Payer: Cofinity Commercial	$1,407.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,197.71
Rate for Payer: Healthscope Commercial	$1,497.14
Rate for Payer: Healthscope Whirlpool	$1,452.23
Rate for Payer: Mclaren Commercial	$1,347.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,272.57
Rate for Payer: Nomi Health Commercial	$1,227.65
Rate for Payer: Priority Health Cigna Priority Health	$973.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,311.79
Rate for Payer: Priority Health Narrow Network	$1,049.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,317.48

HC BRACE ANKLE STIRRUP SPLINT

Facility

$147.44

Service Code	HCPCS L4350
Hospital Charge Code	27400001
Hospital Revenue Code	274
Min. Negotiated Rate	$58.98
Max. Negotiated Rate	$147.44
Rate for Payer: Aetna Commercial	$132.70
Rate for Payer: Aetna Medicare	$73.72
Rate for Payer: ASR ASR	$143.02
Rate for Payer: ASR Commercial	$143.02
Rate for Payer: BCBS Complete	$58.98
Rate for Payer: BCBS Trust/PPO	$120.74
Rate for Payer: BCN Commercial	$114.31
Rate for Payer: Cash Price	$117.95
Rate for Payer: Cofinity Commercial	$138.59
Rate for Payer: Encore Health Key Benefits Commercial	$117.95
Rate for Payer: Healthscope Commercial	$147.44
Rate for Payer: Healthscope Whirlpool	$143.02
Rate for Payer: Mclaren Commercial	$132.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.32
Rate for Payer: Nomi Health Commercial	$120.90
Rate for Payer: Priority Health Cigna Priority Health	$95.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.19
Rate for Payer: Priority Health Narrow Network	$103.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$129.75

HC BRACE ANKLE STIRRUP SPLINT

Facility

$147.44

Service Code	HCPCS L4350
Hospital Charge Code	27400001
Hospital Revenue Code	274
Min. Negotiated Rate	$95.84
Max. Negotiated Rate	$147.44
Rate for Payer: Aetna Commercial	$132.70
Rate for Payer: ASR ASR	$143.02
Rate for Payer: ASR Commercial	$143.02
Rate for Payer: BCBS Trust/PPO	$120.15
Rate for Payer: BCN Commercial	$114.31
Rate for Payer: Cash Price	$117.95
Rate for Payer: Cofinity Commercial	$138.59
Rate for Payer: Encore Health Key Benefits Commercial	$117.95
Rate for Payer: Healthscope Commercial	$147.44
Rate for Payer: Healthscope Whirlpool	$143.02
Rate for Payer: Mclaren Commercial	$132.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.32
Rate for Payer: Nomi Health Commercial	$120.90
Rate for Payer: Priority Health Cigna Priority Health	$95.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$129.75

HC BRACE ASPEN COLLAR

Facility

$341.80

Service Code	HCPCS L0172
Hospital Charge Code	27000011
Hospital Revenue Code	274
Min. Negotiated Rate	$136.72
Max. Negotiated Rate	$341.80
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$170.90
Rate for Payer: ASR ASR	$331.55
Rate for Payer: ASR Commercial	$331.55
Rate for Payer: BCBS Complete	$136.72
Rate for Payer: BCBS Trust/PPO	$279.90
Rate for Payer: BCN Commercial	$265.00
Rate for Payer: Cash Price	$273.44
Rate for Payer: Cofinity Commercial	$321.29
Rate for Payer: Encore Health Key Benefits Commercial	$273.44
Rate for Payer: Healthscope Commercial	$341.80
Rate for Payer: Healthscope Whirlpool	$331.55
Rate for Payer: Mclaren Commercial	$307.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$290.53
Rate for Payer: Nomi Health Commercial	$280.28
Rate for Payer: Priority Health Cigna Priority Health	$222.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$299.49
Rate for Payer: Priority Health Narrow Network	$239.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$300.78

HC BRACE ASPEN COLLAR

Facility

$341.80

Service Code	HCPCS L0172
Hospital Charge Code	27000011
Hospital Revenue Code	274
Min. Negotiated Rate	$222.17
Max. Negotiated Rate	$341.80
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: ASR ASR	$331.55
Rate for Payer: ASR Commercial	$331.55
Rate for Payer: BCBS Trust/PPO	$278.53
Rate for Payer: BCN Commercial	$265.00
Rate for Payer: Cash Price	$273.44
Rate for Payer: Cofinity Commercial	$321.29
Rate for Payer: Encore Health Key Benefits Commercial	$273.44
Rate for Payer: Healthscope Commercial	$341.80
Rate for Payer: Healthscope Whirlpool	$331.55
Rate for Payer: Mclaren Commercial	$307.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$290.53
Rate for Payer: Nomi Health Commercial	$280.28
Rate for Payer: Priority Health Cigna Priority Health	$222.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$300.78

HC BRACE BK PROSTH SOCK MULTI-PLY/6

Facility

$302.02

Service Code	HCPCS L8420
Hospital Charge Code	27400024
Hospital Revenue Code	274
Min. Negotiated Rate	$196.31
Max. Negotiated Rate	$302.02
Rate for Payer: Aetna Commercial	$271.82
Rate for Payer: ASR ASR	$292.96
Rate for Payer: ASR Commercial	$292.96
Rate for Payer: BCBS Trust/PPO	$246.12
Rate for Payer: BCN Commercial	$234.16
Rate for Payer: Cash Price	$241.62
Rate for Payer: Cofinity Commercial	$283.90
Rate for Payer: Encore Health Key Benefits Commercial	$241.62
Rate for Payer: Healthscope Commercial	$302.02
Rate for Payer: Healthscope Whirlpool	$292.96
Rate for Payer: Mclaren Commercial	$271.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.72
Rate for Payer: Nomi Health Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$196.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$265.78

HC BRACE BK PROSTH SOCK MULTI-PLY/6

Facility

$302.02

Service Code	HCPCS L8420
Hospital Charge Code	27400024
Hospital Revenue Code	274
Min. Negotiated Rate	$120.81
Max. Negotiated Rate	$302.02
Rate for Payer: Aetna Commercial	$271.82
Rate for Payer: Aetna Medicare	$151.01
Rate for Payer: ASR ASR	$292.96
Rate for Payer: ASR Commercial	$292.96
Rate for Payer: BCBS Complete	$120.81
Rate for Payer: BCBS Trust/PPO	$247.32
Rate for Payer: BCN Commercial	$234.16
Rate for Payer: Cash Price	$241.62
Rate for Payer: Cofinity Commercial	$283.90
Rate for Payer: Encore Health Key Benefits Commercial	$241.62
Rate for Payer: Healthscope Commercial	$302.02
Rate for Payer: Healthscope Whirlpool	$292.96
Rate for Payer: Mclaren Commercial	$271.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.72
Rate for Payer: Nomi Health Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$196.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.63
Rate for Payer: Priority Health Narrow Network	$211.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$265.78

HC BRACE BK PROSTH SOCK SINGLE-PLY/6

Facility

$96.05

Service Code	HCPCS L8470
Hospital Charge Code	27400032
Hospital Revenue Code	274
Min. Negotiated Rate	$62.43
Max. Negotiated Rate	$96.05
Rate for Payer: Aetna Commercial	$86.44
Rate for Payer: ASR ASR	$93.17
Rate for Payer: ASR Commercial	$93.17
Rate for Payer: BCBS Trust/PPO	$78.27
Rate for Payer: BCN Commercial	$74.47
Rate for Payer: Cash Price	$76.84
Rate for Payer: Cofinity Commercial	$90.29
Rate for Payer: Encore Health Key Benefits Commercial	$76.84
Rate for Payer: Healthscope Commercial	$96.05
Rate for Payer: Healthscope Whirlpool	$93.17
Rate for Payer: Mclaren Commercial	$86.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.64
Rate for Payer: Nomi Health Commercial	$78.76
Rate for Payer: Priority Health Cigna Priority Health	$62.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.52

HC BRACE BK PROSTH SOCK SINGLE-PLY/6

Facility

$96.05

Service Code	HCPCS L8470
Hospital Charge Code	27400032
Hospital Revenue Code	274
Min. Negotiated Rate	$38.42
Max. Negotiated Rate	$96.05
Rate for Payer: Aetna Commercial	$86.44
Rate for Payer: Aetna Medicare	$48.02
Rate for Payer: ASR ASR	$93.17
Rate for Payer: ASR Commercial	$93.17
Rate for Payer: BCBS Complete	$38.42
Rate for Payer: BCBS Trust/PPO	$78.66
Rate for Payer: BCN Commercial	$74.47
Rate for Payer: Cash Price	$76.84
Rate for Payer: Cofinity Commercial	$90.29
Rate for Payer: Encore Health Key Benefits Commercial	$76.84
Rate for Payer: Healthscope Commercial	$96.05
Rate for Payer: Healthscope Whirlpool	$93.17
Rate for Payer: Mclaren Commercial	$86.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.64
Rate for Payer: Nomi Health Commercial	$78.76
Rate for Payer: Priority Health Cigna Priority Health	$62.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.16
Rate for Payer: Priority Health Narrow Network	$67.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.52

HC BRACE BK RIGID DRESSING NWB

Facility

$1,121.27

Service Code	HCPCS L5450
Hospital Charge Code	27000013
Hospital Revenue Code	274
Min. Negotiated Rate	$448.51
Max. Negotiated Rate	$1,121.27
Rate for Payer: Aetna Commercial	$1,009.14
Rate for Payer: Aetna Medicare	$560.64
Rate for Payer: ASR ASR	$1,087.63
Rate for Payer: ASR Commercial	$1,087.63
Rate for Payer: BCBS Complete	$448.51
Rate for Payer: BCBS Trust/PPO	$918.21
Rate for Payer: BCN Commercial	$869.32
Rate for Payer: Cash Price	$897.02
Rate for Payer: Cofinity Commercial	$1,053.99
Rate for Payer: Encore Health Key Benefits Commercial	$897.02
Rate for Payer: Healthscope Commercial	$1,121.27
Rate for Payer: Healthscope Whirlpool	$1,087.63
Rate for Payer: Mclaren Commercial	$1,009.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$953.08
Rate for Payer: Nomi Health Commercial	$919.44
Rate for Payer: Priority Health Cigna Priority Health	$728.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$982.46
Rate for Payer: Priority Health Narrow Network	$786.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$986.72

HC BRACE BK RIGID DRESSING NWB

Facility

$1,121.27

Service Code	HCPCS L5450
Hospital Charge Code	27000013
Hospital Revenue Code	274
Min. Negotiated Rate	$728.83
Max. Negotiated Rate	$1,121.27
Rate for Payer: Aetna Commercial	$1,009.14
Rate for Payer: ASR ASR	$1,087.63
Rate for Payer: ASR Commercial	$1,087.63
Rate for Payer: BCBS Trust/PPO	$913.72
Rate for Payer: BCN Commercial	$869.32
Rate for Payer: Cash Price	$897.02
Rate for Payer: Cofinity Commercial	$1,053.99
Rate for Payer: Encore Health Key Benefits Commercial	$897.02
Rate for Payer: Healthscope Commercial	$1,121.27
Rate for Payer: Healthscope Whirlpool	$1,087.63
Rate for Payer: Mclaren Commercial	$1,009.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$953.08
Rate for Payer: Nomi Health Commercial	$919.44
Rate for Payer: Priority Health Cigna Priority Health	$728.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$986.72

HC BRACE CERVICAL COLLAR CUSTOM

Facility

$1,259.02

Service Code	HCPCS L0190
Hospital Charge Code	27000014
Hospital Revenue Code	274
Min. Negotiated Rate	$503.61
Max. Negotiated Rate	$1,259.02
Rate for Payer: Aetna Commercial	$1,133.12
Rate for Payer: Aetna Medicare	$629.51
Rate for Payer: ASR ASR	$1,221.25
Rate for Payer: ASR Commercial	$1,221.25
Rate for Payer: BCBS Complete	$503.61
Rate for Payer: BCBS Trust/PPO	$1,031.01
Rate for Payer: BCN Commercial	$976.12
Rate for Payer: Cash Price	$1,007.22
Rate for Payer: Cofinity Commercial	$1,183.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.22
Rate for Payer: Healthscope Commercial	$1,259.02
Rate for Payer: Healthscope Whirlpool	$1,221.25
Rate for Payer: Mclaren Commercial	$1,133.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.17
Rate for Payer: Nomi Health Commercial	$1,032.40
Rate for Payer: Priority Health Cigna Priority Health	$818.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,103.15
Rate for Payer: Priority Health Narrow Network	$882.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,107.94

HC BRACE CERVICAL COLLAR CUSTOM

Facility

$1,259.02

Service Code	HCPCS L0190
Hospital Charge Code	27000014
Hospital Revenue Code	274
Min. Negotiated Rate	$818.36
Max. Negotiated Rate	$1,259.02
Rate for Payer: Aetna Commercial	$1,133.12
Rate for Payer: ASR ASR	$1,221.25
Rate for Payer: ASR Commercial	$1,221.25
Rate for Payer: BCBS Trust/PPO	$1,025.98
Rate for Payer: BCN Commercial	$976.12
Rate for Payer: Cash Price	$1,007.22
Rate for Payer: Cofinity Commercial	$1,183.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.22
Rate for Payer: Healthscope Commercial	$1,259.02
Rate for Payer: Healthscope Whirlpool	$1,221.25
Rate for Payer: Mclaren Commercial	$1,133.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.17
Rate for Payer: Nomi Health Commercial	$1,032.40
Rate for Payer: Priority Health Cigna Priority Health	$818.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,107.94

HC BRACE CERVICAL THORA EXTENSION

Facility

$1,071.00

Service Code	HCPCS L1499
Hospital Charge Code	27400030
Hospital Revenue Code	274
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$1,071.00
Rate for Payer: Aetna Commercial	$963.90
Rate for Payer: Aetna Medicare	$535.50
Rate for Payer: ASR ASR	$1,038.87
Rate for Payer: ASR Commercial	$1,038.87
Rate for Payer: BCBS Complete	$428.40
Rate for Payer: BCBS Trust/PPO	$877.04
Rate for Payer: BCN Commercial	$830.35
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$1,006.74
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$1,071.00
Rate for Payer: Healthscope Whirlpool	$1,038.87
Rate for Payer: Mclaren Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: Nomi Health Commercial	$878.22
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$938.41
Rate for Payer: Priority Health Narrow Network	$750.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$942.48

HC BRACE CERVICAL THORA EXTENSION

Facility

$1,071.00

Service Code	HCPCS L1499
Hospital Charge Code	27400030
Hospital Revenue Code	274
Min. Negotiated Rate	$696.15
Max. Negotiated Rate	$1,071.00
Rate for Payer: Aetna Commercial	$963.90
Rate for Payer: ASR ASR	$1,038.87
Rate for Payer: ASR Commercial	$1,038.87
Rate for Payer: BCBS Trust/PPO	$872.76
Rate for Payer: BCN Commercial	$830.35
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cofinity Commercial	$1,006.74
Rate for Payer: Encore Health Key Benefits Commercial	$856.80
Rate for Payer: Healthscope Commercial	$1,071.00
Rate for Payer: Healthscope Whirlpool	$1,038.87
Rate for Payer: Mclaren Commercial	$963.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$910.35
Rate for Payer: Nomi Health Commercial	$878.22
Rate for Payer: Priority Health Cigna Priority Health	$696.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$942.48

HC BRACE CTLSO CUSTOM

Facility

$5,882.73

Hospital Charge Code	27000032
Hospital Revenue Code	274
Min. Negotiated Rate	$3,823.77
Max. Negotiated Rate	$5,882.73
Rate for Payer: Aetna Commercial	$5,294.46
Rate for Payer: ASR ASR	$5,706.25
Rate for Payer: ASR Commercial	$5,706.25
Rate for Payer: BCBS Trust/PPO	$4,793.84
Rate for Payer: BCN Commercial	$4,560.88
Rate for Payer: Cash Price	$4,706.18
Rate for Payer: Cofinity Commercial	$5,529.77
Rate for Payer: Encore Health Key Benefits Commercial	$4,706.18
Rate for Payer: Healthscope Commercial	$5,882.73
Rate for Payer: Healthscope Whirlpool	$5,706.25
Rate for Payer: Mclaren Commercial	$5,294.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.32
Rate for Payer: Nomi Health Commercial	$4,823.84
Rate for Payer: Priority Health Cigna Priority Health	$3,823.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,176.80

HC BRACE CTLSO CUSTOM

Facility

$5,882.73

Hospital Charge Code	27000032
Hospital Revenue Code	274
Min. Negotiated Rate	$2,353.09
Max. Negotiated Rate	$5,882.73
Rate for Payer: Aetna Commercial	$5,294.46
Rate for Payer: Aetna Medicare	$2,941.36
Rate for Payer: ASR ASR	$5,706.25
Rate for Payer: ASR Commercial	$5,706.25
Rate for Payer: BCBS Complete	$2,353.09
Rate for Payer: BCBS Trust/PPO	$4,817.37
Rate for Payer: BCN Commercial	$4,560.88
Rate for Payer: Cash Price	$4,706.18
Rate for Payer: Cofinity Commercial	$5,529.77
Rate for Payer: Encore Health Key Benefits Commercial	$4,706.18
Rate for Payer: Healthscope Commercial	$5,882.73
Rate for Payer: Healthscope Whirlpool	$5,706.25
Rate for Payer: Mclaren Commercial	$5,294.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.32
Rate for Payer: Nomi Health Commercial	$4,823.84
Rate for Payer: Priority Health Cigna Priority Health	$3,823.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,154.45
Rate for Payer: Priority Health Narrow Network	$4,123.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,176.80

HC BRACE CTO

Facility

$1,482.06

Service Code	HCPCS L0200
Hospital Charge Code	27400029
Hospital Revenue Code	274
Min. Negotiated Rate	$592.82
Max. Negotiated Rate	$1,482.06
Rate for Payer: Aetna Commercial	$1,333.85
Rate for Payer: Aetna Medicare	$741.03
Rate for Payer: ASR ASR	$1,437.60
Rate for Payer: ASR Commercial	$1,437.60
Rate for Payer: BCBS Complete	$592.82
Rate for Payer: BCBS Trust/PPO	$1,213.66
Rate for Payer: BCN Commercial	$1,149.04
Rate for Payer: Cash Price	$1,185.65
Rate for Payer: Cofinity Commercial	$1,393.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.65
Rate for Payer: Healthscope Commercial	$1,482.06
Rate for Payer: Healthscope Whirlpool	$1,437.60
Rate for Payer: Mclaren Commercial	$1,333.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.75
Rate for Payer: Nomi Health Commercial	$1,215.29
Rate for Payer: Priority Health Cigna Priority Health	$963.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,298.58
Rate for Payer: Priority Health Narrow Network	$1,038.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,304.21

HC BRACE CTO

Facility

$1,482.06

Service Code	HCPCS L0200
Hospital Charge Code	27400029
Hospital Revenue Code	274
Min. Negotiated Rate	$963.34
Max. Negotiated Rate	$1,482.06
Rate for Payer: Aetna Commercial	$1,333.85
Rate for Payer: ASR ASR	$1,437.60
Rate for Payer: ASR Commercial	$1,437.60
Rate for Payer: BCBS Trust/PPO	$1,207.73
Rate for Payer: BCN Commercial	$1,149.04
Rate for Payer: Cash Price	$1,185.65
Rate for Payer: Cofinity Commercial	$1,393.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,185.65
Rate for Payer: Healthscope Commercial	$1,482.06
Rate for Payer: Healthscope Whirlpool	$1,437.60
Rate for Payer: Mclaren Commercial	$1,333.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.75
Rate for Payer: Nomi Health Commercial	$1,215.29
Rate for Payer: Priority Health Cigna Priority Health	$963.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,304.21

HC BRACE CTO REPLACEMENT PADS

Facility

$275.40

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$110.16
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna Commercial	$247.86
Rate for Payer: Aetna Medicare	$137.70
Rate for Payer: ASR ASR	$267.14
Rate for Payer: ASR Commercial	$267.14
Rate for Payer: BCBS Complete	$110.16
Rate for Payer: BCBS Trust/PPO	$225.53
Rate for Payer: BCN Commercial	$213.52
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$258.88
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$275.40
Rate for Payer: Healthscope Whirlpool	$267.14
Rate for Payer: Mclaren Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: Nomi Health Commercial	$225.83
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$241.31
Rate for Payer: Priority Health Narrow Network	$193.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$242.35

HC BRACE CTO REPLACEMENT PADS

Facility

$275.40

Service Code	HCPCS L1499
Hospital Charge Code	27400045
Hospital Revenue Code	274
Min. Negotiated Rate	$179.01
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna Commercial	$247.86
Rate for Payer: ASR ASR	$267.14
Rate for Payer: ASR Commercial	$267.14
Rate for Payer: BCBS Trust/PPO	$224.42
Rate for Payer: BCN Commercial	$213.52
Rate for Payer: Cash Price	$220.32
Rate for Payer: Cofinity Commercial	$258.88
Rate for Payer: Encore Health Key Benefits Commercial	$220.32
Rate for Payer: Healthscope Commercial	$275.40
Rate for Payer: Healthscope Whirlpool	$267.14
Rate for Payer: Mclaren Commercial	$247.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.09
Rate for Payer: Nomi Health Commercial	$225.83
Rate for Payer: Priority Health Cigna Priority Health	$179.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$242.35

Know your out-of-pocket cost for care.

All Charges