Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$70.38
Rate for Payer: Aetna Commercial	$63.34
Rate for Payer: ASR ASR	$68.27
Rate for Payer: ASR Commercial	$68.27
Rate for Payer: BCBS Trust/PPO	$57.35
Rate for Payer: BCN Commercial	$54.57
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$66.16
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$70.38
Rate for Payer: Healthscope Whirlpool	$68.27
Rate for Payer: Mclaren Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: Nomi Health Commercial	$57.71
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.93

HC BRACE D RING SPLINT

Facility

$70.38

Service Code	HCPCS L3908
Hospital Charge Code	27400013
Hospital Revenue Code	274
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$70.38
Rate for Payer: Aetna Commercial	$63.34
Rate for Payer: Aetna Medicare	$35.19
Rate for Payer: ASR ASR	$68.27
Rate for Payer: ASR Commercial	$68.27
Rate for Payer: BCBS Complete	$28.15
Rate for Payer: BCBS Trust/PPO	$57.63
Rate for Payer: BCN Commercial	$54.57
Rate for Payer: Cash Price	$56.30
Rate for Payer: Cofinity Commercial	$66.16
Rate for Payer: Encore Health Key Benefits Commercial	$56.30
Rate for Payer: Healthscope Commercial	$70.38
Rate for Payer: Healthscope Whirlpool	$68.27
Rate for Payer: Mclaren Commercial	$63.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.82
Rate for Payer: Nomi Health Commercial	$57.71
Rate for Payer: Priority Health Cigna Priority Health	$45.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.67
Rate for Payer: Priority Health Narrow Network	$49.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.93

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$700.02
Max. Negotiated Rate	$1,076.95
Rate for Payer: Aetna Commercial	$969.26
Rate for Payer: ASR ASR	$1,044.64
Rate for Payer: ASR Commercial	$1,044.64
Rate for Payer: BCBS Trust/PPO	$877.61
Rate for Payer: BCN Commercial	$834.96
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$1,012.33
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$1,076.95
Rate for Payer: Healthscope Whirlpool	$1,044.64
Rate for Payer: Mclaren Commercial	$969.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: Nomi Health Commercial	$883.10
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$947.72

HC BRACE ELBOW ORTHOSIS

Facility

$1,076.95

Service Code	HCPCS L3760
Hospital Charge Code	27000004
Hospital Revenue Code	274
Min. Negotiated Rate	$430.78
Max. Negotiated Rate	$1,076.95
Rate for Payer: Aetna Commercial	$969.26
Rate for Payer: Aetna Medicare	$538.48
Rate for Payer: ASR ASR	$1,044.64
Rate for Payer: ASR Commercial	$1,044.64
Rate for Payer: BCBS Complete	$430.78
Rate for Payer: BCBS Trust/PPO	$881.91
Rate for Payer: BCN Commercial	$834.96
Rate for Payer: Cash Price	$861.56
Rate for Payer: Cofinity Commercial	$1,012.33
Rate for Payer: Encore Health Key Benefits Commercial	$861.56
Rate for Payer: Healthscope Commercial	$1,076.95
Rate for Payer: Healthscope Whirlpool	$1,044.64
Rate for Payer: Mclaren Commercial	$969.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$915.41
Rate for Payer: Nomi Health Commercial	$883.10
Rate for Payer: Priority Health Cigna Priority Health	$700.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$943.62
Rate for Payer: Priority Health Narrow Network	$754.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$947.72

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$279.48
Max. Negotiated Rate	$698.70
Rate for Payer: Aetna Commercial	$628.83
Rate for Payer: Aetna Medicare	$349.35
Rate for Payer: ASR ASR	$677.74
Rate for Payer: ASR Commercial	$677.74
Rate for Payer: BCBS Complete	$279.48
Rate for Payer: BCBS Trust/PPO	$572.17
Rate for Payer: BCN Commercial	$541.70
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$656.78
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$698.70
Rate for Payer: Healthscope Whirlpool	$677.74
Rate for Payer: Mclaren Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.90
Rate for Payer: Nomi Health Commercial	$572.93
Rate for Payer: Priority Health Cigna Priority Health	$454.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$612.20
Rate for Payer: Priority Health Narrow Network	$489.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$614.86

HC BRACE ELB/WRIST/HAND RIGID W/O JNTS CF

Facility

$698.70

Service Code	HCPCS L3763
Hospital Charge Code	27400047
Hospital Revenue Code	274
Min. Negotiated Rate	$454.16
Max. Negotiated Rate	$698.70
Rate for Payer: Aetna Commercial	$628.83
Rate for Payer: ASR ASR	$677.74
Rate for Payer: ASR Commercial	$677.74
Rate for Payer: BCBS Trust/PPO	$569.37
Rate for Payer: BCN Commercial	$541.70
Rate for Payer: Cash Price	$558.96
Rate for Payer: Cofinity Commercial	$656.78
Rate for Payer: Encore Health Key Benefits Commercial	$558.96
Rate for Payer: Healthscope Commercial	$698.70
Rate for Payer: Healthscope Whirlpool	$677.74
Rate for Payer: Mclaren Commercial	$628.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$593.90
Rate for Payer: Nomi Health Commercial	$572.93
Rate for Payer: Priority Health Cigna Priority Health	$454.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$614.86

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: Aetna Medicare	$20.40
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Complete	$16.32
Rate for Payer: BCBS Trust/PPO	$33.41
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.75
Rate for Payer: Priority Health Narrow Network	$28.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC BRACE FOREFOOT RELIEF SHOE

Facility

$40.80

Service Code	HCPCS A9283
Hospital Charge Code	27000005
Hospital Revenue Code	274
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna Commercial	$36.72
Rate for Payer: ASR ASR	$39.58
Rate for Payer: ASR Commercial	$39.58
Rate for Payer: BCBS Trust/PPO	$33.25
Rate for Payer: BCN Commercial	$31.63
Rate for Payer: Cash Price	$32.64
Rate for Payer: Cofinity Commercial	$38.35
Rate for Payer: Encore Health Key Benefits Commercial	$32.64
Rate for Payer: Healthscope Commercial	$40.80
Rate for Payer: Healthscope Whirlpool	$39.58
Rate for Payer: Mclaren Commercial	$36.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.68
Rate for Payer: Nomi Health Commercial	$33.46
Rate for Payer: Priority Health Cigna Priority Health	$26.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$35.90

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$79.97
Max. Negotiated Rate	$199.92
Rate for Payer: Aetna Commercial	$179.93
Rate for Payer: Aetna Medicare	$99.96
Rate for Payer: ASR ASR	$193.92
Rate for Payer: ASR Commercial	$193.92
Rate for Payer: BCBS Complete	$79.97
Rate for Payer: BCBS Trust/PPO	$163.71
Rate for Payer: BCN Commercial	$155.00
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$187.92
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$199.92
Rate for Payer: Healthscope Whirlpool	$193.92
Rate for Payer: Mclaren Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: Nomi Health Commercial	$163.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$175.17
Rate for Payer: Priority Health Narrow Network	$140.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$175.93

HC BRACE FO W/O JOINTS CF

Facility

$199.92

Service Code	HCPCS L3933
Hospital Charge Code	27400043
Hospital Revenue Code	274
Min. Negotiated Rate	$129.95
Max. Negotiated Rate	$199.92
Rate for Payer: Aetna Commercial	$179.93
Rate for Payer: ASR ASR	$193.92
Rate for Payer: ASR Commercial	$193.92
Rate for Payer: BCBS Trust/PPO	$162.91
Rate for Payer: BCN Commercial	$155.00
Rate for Payer: Cash Price	$159.94
Rate for Payer: Cofinity Commercial	$187.92
Rate for Payer: Encore Health Key Benefits Commercial	$159.94
Rate for Payer: Healthscope Commercial	$199.92
Rate for Payer: Healthscope Whirlpool	$193.92
Rate for Payer: Mclaren Commercial	$179.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.93
Rate for Payer: Nomi Health Commercial	$163.93
Rate for Payer: Priority Health Cigna Priority Health	$129.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$175.93

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$274.73
Max. Negotiated Rate	$422.66
Rate for Payer: Aetna Commercial	$380.39
Rate for Payer: ASR ASR	$409.98
Rate for Payer: ASR Commercial	$409.98
Rate for Payer: BCBS Trust/PPO	$344.43
Rate for Payer: BCN Commercial	$327.69
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$397.30
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$422.66
Rate for Payer: Healthscope Whirlpool	$409.98
Rate for Payer: Mclaren Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: Nomi Health Commercial	$346.58
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$371.94

HC BRACE FRACTURE BOOT CUSTOM

Facility

$422.66

Service Code	HCPCS L4386
Hospital Charge Code	27400002
Hospital Revenue Code	274
Min. Negotiated Rate	$169.06
Max. Negotiated Rate	$422.66
Rate for Payer: Aetna Commercial	$380.39
Rate for Payer: Aetna Medicare	$211.33
Rate for Payer: ASR ASR	$409.98
Rate for Payer: ASR Commercial	$409.98
Rate for Payer: BCBS Complete	$169.06
Rate for Payer: BCBS Trust/PPO	$346.12
Rate for Payer: BCN Commercial	$327.69
Rate for Payer: Cash Price	$338.13
Rate for Payer: Cofinity Commercial	$397.30
Rate for Payer: Encore Health Key Benefits Commercial	$338.13
Rate for Payer: Healthscope Commercial	$422.66
Rate for Payer: Healthscope Whirlpool	$409.98
Rate for Payer: Mclaren Commercial	$380.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.26
Rate for Payer: Nomi Health Commercial	$346.58
Rate for Payer: Priority Health Cigna Priority Health	$274.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$370.33
Rate for Payer: Priority Health Narrow Network	$296.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$371.94

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$202.87
Max. Negotiated Rate	$507.18
Rate for Payer: Aetna Commercial	$456.46
Rate for Payer: Aetna Medicare	$253.59
Rate for Payer: ASR ASR	$491.96
Rate for Payer: ASR Commercial	$491.96
Rate for Payer: BCBS Complete	$202.87
Rate for Payer: BCBS Trust/PPO	$415.33
Rate for Payer: BCN Commercial	$393.22
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$476.75
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$507.18
Rate for Payer: Healthscope Whirlpool	$491.96
Rate for Payer: Mclaren Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: Nomi Health Commercial	$415.89
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$444.39
Rate for Payer: Priority Health Narrow Network	$355.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$446.32

HC BRACE FRACTURE BOOT OTS

Facility

$507.18

Service Code	HCPCS L4387
Hospital Charge Code	27400022
Hospital Revenue Code	274
Min. Negotiated Rate	$329.67
Max. Negotiated Rate	$507.18
Rate for Payer: Aetna Commercial	$456.46
Rate for Payer: ASR ASR	$491.96
Rate for Payer: ASR Commercial	$491.96
Rate for Payer: BCBS Trust/PPO	$413.30
Rate for Payer: BCN Commercial	$393.22
Rate for Payer: Cash Price	$405.74
Rate for Payer: Cofinity Commercial	$476.75
Rate for Payer: Encore Health Key Benefits Commercial	$405.74
Rate for Payer: Healthscope Commercial	$507.18
Rate for Payer: Healthscope Whirlpool	$491.96
Rate for Payer: Mclaren Commercial	$456.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.10
Rate for Payer: Nomi Health Commercial	$415.89
Rate for Payer: Priority Health Cigna Priority Health	$329.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$446.32

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$194.92
Max. Negotiated Rate	$299.88
Rate for Payer: Aetna Commercial	$269.89
Rate for Payer: ASR ASR	$290.88
Rate for Payer: ASR Commercial	$290.88
Rate for Payer: BCBS Trust/PPO	$244.37
Rate for Payer: BCN Commercial	$232.50
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$281.89
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$299.88
Rate for Payer: Healthscope Whirlpool	$290.88
Rate for Payer: Mclaren Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: Nomi Health Commercial	$245.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$263.89

HC BRACE HAND/FINGER ORTHOSIS

Facility

$299.88

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$119.95
Max. Negotiated Rate	$299.88
Rate for Payer: Aetna Commercial	$269.89
Rate for Payer: Aetna Medicare	$149.94
Rate for Payer: ASR ASR	$290.88
Rate for Payer: ASR Commercial	$290.88
Rate for Payer: BCBS Complete	$119.95
Rate for Payer: BCBS Trust/PPO	$245.57
Rate for Payer: BCN Commercial	$232.50
Rate for Payer: Cash Price	$239.90
Rate for Payer: Cofinity Commercial	$281.89
Rate for Payer: Encore Health Key Benefits Commercial	$239.90
Rate for Payer: Healthscope Commercial	$299.88
Rate for Payer: Healthscope Whirlpool	$290.88
Rate for Payer: Mclaren Commercial	$269.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.90
Rate for Payer: Nomi Health Commercial	$245.90
Rate for Payer: Priority Health Cigna Priority Health	$194.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$262.75
Rate for Payer: Priority Health Narrow Network	$210.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$263.89

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$334.07
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$462.56
Rate for Payer: ASR ASR	$498.54
Rate for Payer: ASR Commercial	$498.54
Rate for Payer: BCBS Trust/PPO	$418.83
Rate for Payer: BCN Commercial	$398.47
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$483.12
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$513.96
Rate for Payer: Healthscope Whirlpool	$498.54
Rate for Payer: Mclaren Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: Nomi Health Commercial	$421.45
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$452.28

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$513.96

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$205.58
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$462.56
Rate for Payer: Aetna Medicare	$256.98
Rate for Payer: ASR ASR	$498.54
Rate for Payer: ASR Commercial	$498.54
Rate for Payer: BCBS Complete	$205.58
Rate for Payer: BCBS Trust/PPO	$420.88
Rate for Payer: BCN Commercial	$398.47
Rate for Payer: Cash Price	$411.17
Rate for Payer: Cofinity Commercial	$483.12
Rate for Payer: Encore Health Key Benefits Commercial	$411.17
Rate for Payer: Healthscope Commercial	$513.96
Rate for Payer: Healthscope Whirlpool	$498.54
Rate for Payer: Mclaren Commercial	$462.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.87
Rate for Payer: Nomi Health Commercial	$421.45
Rate for Payer: Priority Health Cigna Priority Health	$334.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.33
Rate for Payer: Priority Health Narrow Network	$360.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$452.28

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$273.51
Max. Negotiated Rate	$420.79
Rate for Payer: Aetna Commercial	$378.71
Rate for Payer: ASR ASR	$408.17
Rate for Payer: ASR Commercial	$408.17
Rate for Payer: BCBS Trust/PPO	$342.90
Rate for Payer: BCN Commercial	$326.24
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$395.54
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$420.79
Rate for Payer: Healthscope Whirlpool	$408.17
Rate for Payer: Mclaren Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: Nomi Health Commercial	$345.05
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.30

HC BRACE HARD HELMET

Facility

$420.79

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$168.32
Max. Negotiated Rate	$420.79
Rate for Payer: Aetna Commercial	$378.71
Rate for Payer: Aetna Medicare	$210.40
Rate for Payer: ASR ASR	$408.17
Rate for Payer: ASR Commercial	$408.17
Rate for Payer: BCBS Complete	$168.32
Rate for Payer: BCBS Trust/PPO	$344.58
Rate for Payer: BCN Commercial	$326.24
Rate for Payer: Cash Price	$336.63
Rate for Payer: Cofinity Commercial	$395.54
Rate for Payer: Encore Health Key Benefits Commercial	$336.63
Rate for Payer: Healthscope Commercial	$420.79
Rate for Payer: Healthscope Whirlpool	$408.17
Rate for Payer: Mclaren Commercial	$378.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.67
Rate for Payer: Nomi Health Commercial	$345.05
Rate for Payer: Priority Health Cigna Priority Health	$273.51
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$368.70
Rate for Payer: Priority Health Narrow Network	$294.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.30

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$119.34
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$165.24
Rate for Payer: ASR ASR	$178.09
Rate for Payer: ASR Commercial	$178.09
Rate for Payer: BCBS Trust/PPO	$149.62
Rate for Payer: BCN Commercial	$142.35
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$172.58
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Healthscope Whirlpool	$178.09
Rate for Payer: Mclaren Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: Nomi Health Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$161.57

HC BRACE HEEL RELIEF SHOE

Facility

$183.60

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna Commercial	$165.24
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: ASR ASR	$178.09
Rate for Payer: ASR Commercial	$178.09
Rate for Payer: BCBS Complete	$73.44
Rate for Payer: BCBS Trust/PPO	$150.35
Rate for Payer: BCN Commercial	$142.35
Rate for Payer: Cash Price	$146.88
Rate for Payer: Cofinity Commercial	$172.58
Rate for Payer: Encore Health Key Benefits Commercial	$146.88
Rate for Payer: Healthscope Commercial	$183.60
Rate for Payer: Healthscope Whirlpool	$178.09
Rate for Payer: Mclaren Commercial	$165.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.06
Rate for Payer: Nomi Health Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$119.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$160.87
Rate for Payer: Priority Health Narrow Network	$128.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$161.57

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$114.75
Rate for Payer: Aetna Medicare	$63.75
Rate for Payer: ASR ASR	$123.68
Rate for Payer: ASR Commercial	$123.68
Rate for Payer: BCBS Complete	$51.00
Rate for Payer: BCBS Trust/PPO	$104.41
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$119.85
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$127.50
Rate for Payer: Healthscope Whirlpool	$123.68
Rate for Payer: Mclaren Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: Nomi Health Commercial	$104.55
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$111.72
Rate for Payer: Priority Health Narrow Network	$89.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$112.20

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$127.50

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$114.75
Rate for Payer: ASR ASR	$123.68
Rate for Payer: ASR Commercial	$123.68
Rate for Payer: BCBS Trust/PPO	$103.90
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cofinity Commercial	$119.85
Rate for Payer: Encore Health Key Benefits Commercial	$102.00
Rate for Payer: Healthscope Commercial	$127.50
Rate for Payer: Healthscope Whirlpool	$123.68
Rate for Payer: Mclaren Commercial	$114.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.38
Rate for Payer: Nomi Health Commercial	$104.55
Rate for Payer: Priority Health Cigna Priority Health	$82.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$112.20

HC BRACE HFO W/O JOINTS CF

Facility

$258.02

Service Code	HCPCS L3913
Hospital Charge Code	27400042
Hospital Revenue Code	274
Min. Negotiated Rate	$103.21
Max. Negotiated Rate	$258.02
Rate for Payer: Aetna Commercial	$232.22
Rate for Payer: Aetna Medicare	$129.01
Rate for Payer: ASR ASR	$250.28
Rate for Payer: ASR Commercial	$250.28
Rate for Payer: BCBS Complete	$103.21
Rate for Payer: BCBS Trust/PPO	$211.29
Rate for Payer: BCN Commercial	$200.04
Rate for Payer: Cash Price	$206.42
Rate for Payer: Cofinity Commercial	$242.54
Rate for Payer: Encore Health Key Benefits Commercial	$206.42
Rate for Payer: Healthscope Commercial	$258.02
Rate for Payer: Healthscope Whirlpool	$250.28
Rate for Payer: Mclaren Commercial	$232.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.32
Rate for Payer: Nomi Health Commercial	$211.58
Rate for Payer: Priority Health Cigna Priority Health	$167.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$226.08
Rate for Payer: Priority Health Narrow Network	$180.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$227.06

Know your out-of-pocket cost for care.

All Charges