Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$537.89

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$215.16
Max. Negotiated Rate	$537.89
Rate for Payer: Aetna Commercial	$484.10
Rate for Payer: Aetna Medicare	$268.94
Rate for Payer: ASR ASR	$521.75
Rate for Payer: ASR Commercial	$521.75
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCBS Trust/PPO	$440.48
Rate for Payer: BCN Commercial	$417.03
Rate for Payer: Cash Price	$430.31
Rate for Payer: Cofinity Commercial	$505.62
Rate for Payer: Encore Health Key Benefits Commercial	$430.31
Rate for Payer: Healthscope Commercial	$537.89
Rate for Payer: Healthscope Whirlpool	$521.75
Rate for Payer: Mclaren Commercial	$484.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.21
Rate for Payer: Nomi Health Commercial	$441.07
Rate for Payer: Priority Health Cigna Priority Health	$349.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$471.30
Rate for Payer: Priority Health Narrow Network	$377.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$473.34

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$537.89

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$349.63
Max. Negotiated Rate	$537.89
Rate for Payer: Aetna Commercial	$484.10
Rate for Payer: ASR ASR	$521.75
Rate for Payer: ASR Commercial	$521.75
Rate for Payer: BCBS Trust/PPO	$438.33
Rate for Payer: BCN Commercial	$417.03
Rate for Payer: Cash Price	$430.31
Rate for Payer: Cofinity Commercial	$505.62
Rate for Payer: Encore Health Key Benefits Commercial	$430.31
Rate for Payer: Healthscope Commercial	$537.89
Rate for Payer: Healthscope Whirlpool	$521.75
Rate for Payer: Mclaren Commercial	$484.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$457.21
Rate for Payer: Nomi Health Commercial	$441.07
Rate for Payer: Priority Health Cigna Priority Health	$349.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$473.34

HC BRACE SOFT COLLAR

Facility

$60.66

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$60.66
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare	$30.33
Rate for Payer: ASR ASR	$58.84
Rate for Payer: ASR Commercial	$58.84
Rate for Payer: BCBS Complete	$24.26
Rate for Payer: BCBS Trust/PPO	$49.67
Rate for Payer: BCN Commercial	$47.03
Rate for Payer: Cash Price	$48.53
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Encore Health Key Benefits Commercial	$48.53
Rate for Payer: Healthscope Commercial	$60.66
Rate for Payer: Healthscope Whirlpool	$58.84
Rate for Payer: Mclaren Commercial	$54.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.56
Rate for Payer: Nomi Health Commercial	$49.74
Rate for Payer: Priority Health Cigna Priority Health	$39.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53.15
Rate for Payer: Priority Health Narrow Network	$42.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.38

HC BRACE SOFT COLLAR

Facility

$60.66

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$39.43
Max. Negotiated Rate	$60.66
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: ASR ASR	$58.84
Rate for Payer: ASR Commercial	$58.84
Rate for Payer: BCBS Trust/PPO	$49.43
Rate for Payer: BCN Commercial	$47.03
Rate for Payer: Cash Price	$48.53
Rate for Payer: Cofinity Commercial	$57.02
Rate for Payer: Encore Health Key Benefits Commercial	$48.53
Rate for Payer: Healthscope Commercial	$60.66
Rate for Payer: Healthscope Whirlpool	$58.84
Rate for Payer: Mclaren Commercial	$54.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.56
Rate for Payer: Nomi Health Commercial	$49.74
Rate for Payer: Priority Health Cigna Priority Health	$39.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.38

HC BRACE SOFT HELMET

Facility

$315.66

Service Code	HCPCS A8000
Hospital Charge Code	27000006
Hospital Revenue Code	274
Min. Negotiated Rate	$205.18
Max. Negotiated Rate	$315.66
Rate for Payer: Aetna Commercial	$284.09
Rate for Payer: ASR ASR	$306.19
Rate for Payer: ASR Commercial	$306.19
Rate for Payer: BCBS Trust/PPO	$257.23
Rate for Payer: BCN Commercial	$244.73
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cofinity Commercial	$296.72
Rate for Payer: Encore Health Key Benefits Commercial	$252.53
Rate for Payer: Healthscope Commercial	$315.66
Rate for Payer: Healthscope Whirlpool	$306.19
Rate for Payer: Mclaren Commercial	$284.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.31
Rate for Payer: Nomi Health Commercial	$258.84
Rate for Payer: Priority Health Cigna Priority Health	$205.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.78

HC BRACE SOFT HELMET

Facility

$315.66

Service Code	HCPCS A8000
Hospital Charge Code	27000006
Hospital Revenue Code	274
Min. Negotiated Rate	$126.26
Max. Negotiated Rate	$315.66
Rate for Payer: Aetna Commercial	$284.09
Rate for Payer: Aetna Medicare	$157.83
Rate for Payer: ASR ASR	$306.19
Rate for Payer: ASR Commercial	$306.19
Rate for Payer: BCBS Complete	$126.26
Rate for Payer: BCBS Trust/PPO	$258.49
Rate for Payer: BCN Commercial	$244.73
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cofinity Commercial	$296.72
Rate for Payer: Encore Health Key Benefits Commercial	$252.53
Rate for Payer: Healthscope Commercial	$315.66
Rate for Payer: Healthscope Whirlpool	$306.19
Rate for Payer: Mclaren Commercial	$284.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.31
Rate for Payer: Nomi Health Commercial	$258.84
Rate for Payer: Priority Health Cigna Priority Health	$205.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.58
Rate for Payer: Priority Health Narrow Network	$221.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.78

HC BRACE STUMP SHRINKER AK

Facility

$157.10

Service Code	HCPCS L8460
Hospital Charge Code	27000015
Hospital Revenue Code	274
Min. Negotiated Rate	$102.11
Max. Negotiated Rate	$157.10
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: ASR ASR	$152.39
Rate for Payer: ASR Commercial	$152.39
Rate for Payer: BCBS Trust/PPO	$128.02
Rate for Payer: BCN Commercial	$121.80
Rate for Payer: Cash Price	$125.68
Rate for Payer: Cofinity Commercial	$147.67
Rate for Payer: Encore Health Key Benefits Commercial	$125.68
Rate for Payer: Healthscope Commercial	$157.10
Rate for Payer: Healthscope Whirlpool	$152.39
Rate for Payer: Mclaren Commercial	$141.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.53
Rate for Payer: Nomi Health Commercial	$128.82
Rate for Payer: Priority Health Cigna Priority Health	$102.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$138.25

HC BRACE STUMP SHRINKER AK

Facility

$157.10

Service Code	HCPCS L8460
Hospital Charge Code	27000015
Hospital Revenue Code	274
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$157.10
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: Aetna Medicare	$78.55
Rate for Payer: ASR ASR	$152.39
Rate for Payer: ASR Commercial	$152.39
Rate for Payer: BCBS Complete	$62.84
Rate for Payer: BCBS Trust/PPO	$128.65
Rate for Payer: BCN Commercial	$121.80
Rate for Payer: Cash Price	$125.68
Rate for Payer: Cofinity Commercial	$147.67
Rate for Payer: Encore Health Key Benefits Commercial	$125.68
Rate for Payer: Healthscope Commercial	$157.10
Rate for Payer: Healthscope Whirlpool	$152.39
Rate for Payer: Mclaren Commercial	$141.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.53
Rate for Payer: Nomi Health Commercial	$128.82
Rate for Payer: Priority Health Cigna Priority Health	$102.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.65
Rate for Payer: Priority Health Narrow Network	$110.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$138.25

HC BRACE STUMP SHRINKER BK

Facility

$110.53

Service Code	HCPCS L8440
Hospital Charge Code	27000016
Hospital Revenue Code	274
Min. Negotiated Rate	$71.84
Max. Negotiated Rate	$110.53
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: ASR ASR	$107.21
Rate for Payer: ASR Commercial	$107.21
Rate for Payer: BCBS Trust/PPO	$90.07
Rate for Payer: BCN Commercial	$85.69
Rate for Payer: Cash Price	$88.42
Rate for Payer: Cofinity Commercial	$103.90
Rate for Payer: Encore Health Key Benefits Commercial	$88.42
Rate for Payer: Healthscope Commercial	$110.53
Rate for Payer: Healthscope Whirlpool	$107.21
Rate for Payer: Mclaren Commercial	$99.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.95
Rate for Payer: Nomi Health Commercial	$90.63
Rate for Payer: Priority Health Cigna Priority Health	$71.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.27

HC BRACE STUMP SHRINKER BK

Facility

$110.53

Service Code	HCPCS L8440
Hospital Charge Code	27000016
Hospital Revenue Code	274
Min. Negotiated Rate	$44.21
Max. Negotiated Rate	$110.53
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: Aetna Medicare	$55.27
Rate for Payer: ASR ASR	$107.21
Rate for Payer: ASR Commercial	$107.21
Rate for Payer: BCBS Complete	$44.21
Rate for Payer: BCBS Trust/PPO	$90.51
Rate for Payer: BCN Commercial	$85.69
Rate for Payer: Cash Price	$88.42
Rate for Payer: Cofinity Commercial	$103.90
Rate for Payer: Encore Health Key Benefits Commercial	$88.42
Rate for Payer: Healthscope Commercial	$110.53
Rate for Payer: Healthscope Whirlpool	$107.21
Rate for Payer: Mclaren Commercial	$99.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.95
Rate for Payer: Nomi Health Commercial	$90.63
Rate for Payer: Priority Health Cigna Priority Health	$71.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$96.85
Rate for Payer: Priority Health Narrow Network	$77.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.27

HC BRACE THUMB SPICA SPLINT

Facility

$98.42

Service Code	HCPCS L3908
Hospital Charge Code	27400017
Hospital Revenue Code	274
Min. Negotiated Rate	$63.97
Max. Negotiated Rate	$98.42
Rate for Payer: Aetna Commercial	$88.58
Rate for Payer: ASR ASR	$95.47
Rate for Payer: ASR Commercial	$95.47
Rate for Payer: BCBS Trust/PPO	$80.20
Rate for Payer: BCN Commercial	$76.31
Rate for Payer: Cash Price	$78.74
Rate for Payer: Cofinity Commercial	$92.51
Rate for Payer: Encore Health Key Benefits Commercial	$78.74
Rate for Payer: Healthscope Commercial	$98.42
Rate for Payer: Healthscope Whirlpool	$95.47
Rate for Payer: Mclaren Commercial	$88.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.66
Rate for Payer: Nomi Health Commercial	$80.70
Rate for Payer: Priority Health Cigna Priority Health	$63.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$86.61

HC BRACE THUMB SPICA SPLINT

Facility

$98.42

Service Code	HCPCS L3908
Hospital Charge Code	27400017
Hospital Revenue Code	274
Min. Negotiated Rate	$39.37
Max. Negotiated Rate	$98.42
Rate for Payer: Aetna Commercial	$88.58
Rate for Payer: Aetna Medicare	$49.21
Rate for Payer: ASR ASR	$95.47
Rate for Payer: ASR Commercial	$95.47
Rate for Payer: BCBS Complete	$39.37
Rate for Payer: BCBS Trust/PPO	$80.60
Rate for Payer: BCN Commercial	$76.31
Rate for Payer: Cash Price	$78.74
Rate for Payer: Cofinity Commercial	$92.51
Rate for Payer: Encore Health Key Benefits Commercial	$78.74
Rate for Payer: Healthscope Commercial	$98.42
Rate for Payer: Healthscope Whirlpool	$95.47
Rate for Payer: Mclaren Commercial	$88.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.66
Rate for Payer: Nomi Health Commercial	$80.70
Rate for Payer: Priority Health Cigna Priority Health	$63.97
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.24
Rate for Payer: Priority Health Narrow Network	$68.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$86.61

HC BRACE TLSO

Facility

$3,264.00

Service Code	HCPCS L0486
Hospital Charge Code	27400007
Hospital Revenue Code	274
Min. Negotiated Rate	$2,121.60
Max. Negotiated Rate	$3,264.00
Rate for Payer: Aetna Commercial	$2,937.60
Rate for Payer: ASR ASR	$3,166.08
Rate for Payer: ASR Commercial	$3,166.08
Rate for Payer: BCBS Trust/PPO	$2,659.83
Rate for Payer: BCN Commercial	$2,530.58
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$3,068.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$3,264.00
Rate for Payer: Healthscope Whirlpool	$3,166.08
Rate for Payer: Mclaren Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: Nomi Health Commercial	$2,676.48
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,872.32

HC BRACE TLSO

Facility

$3,264.00

Service Code	HCPCS L0486
Hospital Charge Code	27400007
Hospital Revenue Code	274
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$3,264.00
Rate for Payer: Aetna Commercial	$2,937.60
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: ASR ASR	$3,166.08
Rate for Payer: ASR Commercial	$3,166.08
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: BCBS Trust/PPO	$2,672.89
Rate for Payer: BCN Commercial	$2,530.58
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Cofinity Commercial	$3,068.16
Rate for Payer: Encore Health Key Benefits Commercial	$2,611.20
Rate for Payer: Healthscope Commercial	$3,264.00
Rate for Payer: Healthscope Whirlpool	$3,166.08
Rate for Payer: Mclaren Commercial	$2,937.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,774.40
Rate for Payer: Nomi Health Commercial	$2,676.48
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,859.92
Rate for Payer: Priority Health Narrow Network	$2,288.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,872.32

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,960.84
Max. Negotiated Rate	$3,016.68
Rate for Payer: Aetna Commercial	$2,715.01
Rate for Payer: ASR ASR	$2,926.18
Rate for Payer: ASR Commercial	$2,926.18
Rate for Payer: BCBS Trust/PPO	$2,458.29
Rate for Payer: BCN Commercial	$2,338.83
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,835.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$3,016.68
Rate for Payer: Healthscope Whirlpool	$2,926.18
Rate for Payer: Mclaren Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: Nomi Health Commercial	$2,473.68
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,654.68

HC BRACE TLSO PREFAB

Facility

$3,016.68

Service Code	HCPCS L0464
Hospital Charge Code	27400037
Hospital Revenue Code	274
Min. Negotiated Rate	$1,206.67
Max. Negotiated Rate	$3,016.68
Rate for Payer: Aetna Commercial	$2,715.01
Rate for Payer: Aetna Medicare	$1,508.34
Rate for Payer: ASR ASR	$2,926.18
Rate for Payer: ASR Commercial	$2,926.18
Rate for Payer: BCBS Complete	$1,206.67
Rate for Payer: BCBS Trust/PPO	$2,470.36
Rate for Payer: BCN Commercial	$2,338.83
Rate for Payer: Cash Price	$2,413.34
Rate for Payer: Cofinity Commercial	$2,835.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,413.34
Rate for Payer: Healthscope Commercial	$3,016.68
Rate for Payer: Healthscope Whirlpool	$2,926.18
Rate for Payer: Mclaren Commercial	$2,715.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,564.18
Rate for Payer: Nomi Health Commercial	$2,473.68
Rate for Payer: Priority Health Cigna Priority Health	$1,960.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,643.22
Rate for Payer: Priority Health Narrow Network	$2,114.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,654.68

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$801.42
Max. Negotiated Rate	$2,003.54
Rate for Payer: Aetna Commercial	$1,803.19
Rate for Payer: Aetna Medicare	$1,001.77
Rate for Payer: ASR ASR	$1,943.43
Rate for Payer: ASR Commercial	$1,943.43
Rate for Payer: BCBS Complete	$801.42
Rate for Payer: BCBS Trust/PPO	$1,640.70
Rate for Payer: BCN Commercial	$1,553.34
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,883.33
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$2,003.54
Rate for Payer: Healthscope Whirlpool	$1,943.43
Rate for Payer: Mclaren Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: Nomi Health Commercial	$1,642.90
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,755.50
Rate for Payer: Priority Health Narrow Network	$1,404.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,763.12

HC BRACE TLSO PREFAB CUSTOM FIT

Facility

$2,003.54

Service Code	HCPCS L0460
Hospital Charge Code	27400023
Hospital Revenue Code	274
Min. Negotiated Rate	$1,302.30
Max. Negotiated Rate	$2,003.54
Rate for Payer: Aetna Commercial	$1,803.19
Rate for Payer: ASR ASR	$1,943.43
Rate for Payer: ASR Commercial	$1,943.43
Rate for Payer: BCBS Trust/PPO	$1,632.68
Rate for Payer: BCN Commercial	$1,553.34
Rate for Payer: Cash Price	$1,602.83
Rate for Payer: Cofinity Commercial	$1,883.33
Rate for Payer: Encore Health Key Benefits Commercial	$1,602.83
Rate for Payer: Healthscope Commercial	$2,003.54
Rate for Payer: Healthscope Whirlpool	$1,943.43
Rate for Payer: Mclaren Commercial	$1,803.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.01
Rate for Payer: Nomi Health Commercial	$1,642.90
Rate for Payer: Priority Health Cigna Priority Health	$1,302.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,763.12

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$47.94
Rate for Payer: Aetna Commercial	$43.15
Rate for Payer: ASR ASR	$46.50
Rate for Payer: ASR Commercial	$46.50
Rate for Payer: BCBS Trust/PPO	$39.07
Rate for Payer: BCN Commercial	$37.17
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$45.06
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$47.94
Rate for Payer: Healthscope Whirlpool	$46.50
Rate for Payer: Mclaren Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: Nomi Health Commercial	$39.31
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.19

HC BRACE UE FX RAD/ULNAR ORTHOSIS

Facility

$47.94

Service Code	HCPCS L3982
Hospital Charge Code	27400026
Hospital Revenue Code	274
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$47.94
Rate for Payer: Aetna Commercial	$43.15
Rate for Payer: Aetna Medicare	$23.97
Rate for Payer: ASR ASR	$46.50
Rate for Payer: ASR Commercial	$46.50
Rate for Payer: BCBS Complete	$19.18
Rate for Payer: BCBS Trust/PPO	$39.26
Rate for Payer: BCN Commercial	$37.17
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cofinity Commercial	$45.06
Rate for Payer: Encore Health Key Benefits Commercial	$38.35
Rate for Payer: Healthscope Commercial	$47.94
Rate for Payer: Healthscope Whirlpool	$46.50
Rate for Payer: Mclaren Commercial	$43.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.75
Rate for Payer: Nomi Health Commercial	$39.31
Rate for Payer: Priority Health Cigna Priority Health	$31.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.01
Rate for Payer: Priority Health Narrow Network	$33.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$42.19

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$32.53
Rate for Payer: ASR ASR	$35.07
Rate for Payer: ASR Commercial	$35.07
Rate for Payer: BCBS Trust/PPO	$29.46
Rate for Payer: BCN Commercial	$28.03
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$33.98
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$36.15
Rate for Payer: Healthscope Whirlpool	$35.07
Rate for Payer: Mclaren Commercial	$32.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: Nomi Health Commercial	$29.64
Rate for Payer: Priority Health Cigna Priority Health	$23.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.81

HC BRACE UNIVERSAL COCKUP SPLINT

Facility

$36.15

Service Code	HCPCS L3908
Hospital Charge Code	27400012
Hospital Revenue Code	274
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$36.15
Rate for Payer: Aetna Commercial	$32.53
Rate for Payer: Aetna Medicare	$18.07
Rate for Payer: ASR ASR	$35.07
Rate for Payer: ASR Commercial	$35.07
Rate for Payer: BCBS Complete	$14.46
Rate for Payer: BCBS Trust/PPO	$29.60
Rate for Payer: BCN Commercial	$28.03
Rate for Payer: Cash Price	$28.92
Rate for Payer: Cofinity Commercial	$33.98
Rate for Payer: Encore Health Key Benefits Commercial	$28.92
Rate for Payer: Healthscope Commercial	$36.15
Rate for Payer: Healthscope Whirlpool	$35.07
Rate for Payer: Mclaren Commercial	$32.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.73
Rate for Payer: Nomi Health Commercial	$29.64
Rate for Payer: Priority Health Cigna Priority Health	$23.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.67
Rate for Payer: Priority Health Narrow Network	$25.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.81

HC BRACE WAIST BELT

Facility

$147.52

Service Code	HCPCS L5688
Hospital Charge Code	27400031
Hospital Revenue Code	274
Min. Negotiated Rate	$59.01
Max. Negotiated Rate	$147.52
Rate for Payer: Aetna Commercial	$132.77
Rate for Payer: Aetna Medicare	$73.76
Rate for Payer: ASR ASR	$143.09
Rate for Payer: ASR Commercial	$143.09
Rate for Payer: BCBS Complete	$59.01
Rate for Payer: BCBS Trust/PPO	$120.80
Rate for Payer: BCN Commercial	$114.37
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cofinity Commercial	$138.67
Rate for Payer: Encore Health Key Benefits Commercial	$118.02
Rate for Payer: Healthscope Commercial	$147.52
Rate for Payer: Healthscope Whirlpool	$143.09
Rate for Payer: Mclaren Commercial	$132.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.39
Rate for Payer: Nomi Health Commercial	$120.97
Rate for Payer: Priority Health Cigna Priority Health	$95.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$129.26
Rate for Payer: Priority Health Narrow Network	$103.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$129.82

HC BRACE WAIST BELT

Facility

$147.52

Service Code	HCPCS L5688
Hospital Charge Code	27400031
Hospital Revenue Code	274
Min. Negotiated Rate	$95.89
Max. Negotiated Rate	$147.52
Rate for Payer: Aetna Commercial	$132.77
Rate for Payer: ASR ASR	$143.09
Rate for Payer: ASR Commercial	$143.09
Rate for Payer: BCBS Trust/PPO	$120.21
Rate for Payer: BCN Commercial	$114.37
Rate for Payer: Cash Price	$118.02
Rate for Payer: Cofinity Commercial	$138.67
Rate for Payer: Encore Health Key Benefits Commercial	$118.02
Rate for Payer: Healthscope Commercial	$147.52
Rate for Payer: Healthscope Whirlpool	$143.09
Rate for Payer: Mclaren Commercial	$132.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.39
Rate for Payer: Nomi Health Commercial	$120.97
Rate for Payer: Priority Health Cigna Priority Health	$95.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$129.82

HC BRACE WHFO RIGID W/O JOINTS

Facility

$339.17

Service Code	HCPCS L3808
Hospital Charge Code	27400040
Hospital Revenue Code	274
Min. Negotiated Rate	$135.67
Max. Negotiated Rate	$339.17
Rate for Payer: Aetna Commercial	$305.25
Rate for Payer: Aetna Medicare	$169.59
Rate for Payer: ASR ASR	$328.99
Rate for Payer: ASR Commercial	$328.99
Rate for Payer: BCBS Complete	$135.67
Rate for Payer: BCBS Trust/PPO	$277.75
Rate for Payer: BCN Commercial	$262.96
Rate for Payer: Cash Price	$271.34
Rate for Payer: Cofinity Commercial	$318.82
Rate for Payer: Encore Health Key Benefits Commercial	$271.34
Rate for Payer: Healthscope Commercial	$339.17
Rate for Payer: Healthscope Whirlpool	$328.99
Rate for Payer: Mclaren Commercial	$305.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.29
Rate for Payer: Nomi Health Commercial	$278.12
Rate for Payer: Priority Health Cigna Priority Health	$220.46
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$297.18
Rate for Payer: Priority Health Narrow Network	$237.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$298.47

Know your out-of-pocket cost for care.

All Charges