|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.38 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.12
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS MAPPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.38
|
| Rate for Payer: BCN Commercial |
$194.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Senior Care Partners |
$59.38
|
| Rate for Payer: PACE SWMI |
$62.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$62.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Medicare |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: Railroad Medicare Medicare |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$62.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.52
|
| Rate for Payer: BCN Commercial |
$212.52
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.81
|
| Rate for Payer: BCN Commercial |
$213.81
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$70.81
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.97 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$231.84
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.25
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.22 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: BCBS Trust/PPO |
$251.16
|
| Rate for Payer: BCN Commercial |
$251.16
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.00
|
| Rate for Payer: UHC Core |
$271.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.19 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna Medicare |
$84.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.56
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$81.25
|
| Rate for Payer: BCBS Trust/PPO |
$252.69
|
| Rate for Payer: BCN Commercial |
$252.69
|
| Rate for Payer: BCN Medicare Advantage |
$81.25
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.25
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PACE Senior Care Partners |
$77.19
|
| Rate for Payer: PACE SWMI |
$81.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: PHP Medicare Advantage |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.75
|
| Rate for Payer: Priority Health Medicare |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.22
|
| Rate for Payer: Railroad Medicare Medicare |
$81.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.00
|
| Rate for Payer: UHC Core |
$271.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.25
|
| Rate for Payer: UHC Medicare Advantage |
$83.69
|
| Rate for Payer: VA VA |
$81.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: BCBS Trust/PPO |
$270.48
|
| Rate for Payer: BCN Commercial |
$270.48
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.38
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$87.50
|
| Rate for Payer: BCBS Trust/PPO |
$272.12
|
| Rate for Payer: BCN Commercial |
$272.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PACE Senior Care Partners |
$83.12
|
| Rate for Payer: PACE SWMI |
$87.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: PHP Medicare Advantage |
$87.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: Railroad Medicare Medicare |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.50
|
| Rate for Payer: UHC Medicare Advantage |
$90.12
|
| Rate for Payer: VA VA |
$87.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.19
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS MAPPO |
$93.75
|
| Rate for Payer: BCBS Trust/PPO |
$291.56
|
| Rate for Payer: BCN Commercial |
$291.56
|
| Rate for Payer: BCN Medicare Advantage |
$93.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.75
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PACE Senior Care Partners |
$89.06
|
| Rate for Payer: PACE SWMI |
$93.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Medicare Advantage |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: Railroad Medicare Medicare |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.75
|
| Rate for Payer: UHC Medicare Advantage |
$96.56
|
| Rate for Payer: VA VA |
$93.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.71 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: BCBS Trust/PPO |
$289.80
|
| Rate for Payer: BCN Commercial |
$289.80
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$31.10
|
| Rate for Payer: BCN Commercial |
$31.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.00
|
| Rate for Payer: UHC Medicare Advantage |
$10.30
|
| Rate for Payer: VA VA |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$30.91
|
| Rate for Payer: BCN Commercial |
$30.91
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$243.96 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: BCBS Trust/PPO |
$309.12
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.00
|
| Rate for Payer: UHC Core |
$334.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.00
|
| Rate for Payer: BCN Commercial |
$311.00
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PACE Senior Care Partners |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.00
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.96
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.00
|
| Rate for Payer: UHC Core |
$334.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.00
|
| Rate for Payer: UHC Medicare Advantage |
$103.00
|
| Rate for Payer: VA VA |
$100.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.81
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$330.44
|
| Rate for Payer: BCN Commercial |
$330.44
|
| Rate for Payer: BCN Medicare Advantage |
$106.25
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PACE Senior Care Partners |
$100.94
|
| Rate for Payer: PACE SWMI |
$106.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: PHP Medicare Advantage |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.75
|
| Rate for Payer: Priority Health Medicare |
$106.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.21
|
| Rate for Payer: Railroad Medicare Medicare |
$106.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.00
|
| Rate for Payer: UHC Core |
$354.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.25
|
| Rate for Payer: UHC Medicare Advantage |
$109.44
|
| Rate for Payer: VA VA |
$106.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.21 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: BCBS Trust/PPO |
$328.44
|
| Rate for Payer: BCN Commercial |
$328.44
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.00
|
| Rate for Payer: UHC Core |
$354.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.88
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.88
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$17.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.02
|
| Rate for Payer: VA VA |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
