|
HC OT Z SLEEVE OR GLOVE EA $175
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: BCBS Trust/PPO |
$145.71
|
| Rate for Payer: BCN Commercial |
$137.94
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health HMO/PPO |
$155.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.08
|
| Rate for Payer: UHC Core |
$149.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.77
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health HMO/PPO |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Exchange |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC OT Z SLEEVE OR GLOVE EA $20
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: Nomi Health Commercial |
$16.73
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health HMO/PPO |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.75
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$167.71
|
| Rate for Payer: BCN Commercial |
$158.61
|
| Rate for Payer: BCN Medicare Advantage |
$51.00
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.00
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: Nomi Health Commercial |
$167.28
|
| Rate for Payer: PACE Senior Care Partners |
$48.45
|
| Rate for Payer: PACE SWMI |
$51.00
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$177.48
|
| Rate for Payer: Priority Health Medicare |
$51.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.68
|
| Rate for Payer: Railroad Medicare Medicare |
$51.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.00
|
| Rate for Payer: UHC Exchange |
$51.00
|
| Rate for Payer: UHC Medicare Advantage |
$51.00
|
| Rate for Payer: VA VA |
$51.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $200
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$166.53
|
| Rate for Payer: BCN Commercial |
$157.65
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: Nomi Health Commercial |
$167.28
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$177.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: BCBS Trust/PPO |
$187.34
|
| Rate for Payer: BCN Commercial |
$177.36
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC OT Z SLEEVE OR GLOVE EA $225
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.51 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.72
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS MAPPO |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$188.67
|
| Rate for Payer: BCN Commercial |
$178.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.38
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.38
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: PACE Senior Care Partners |
$54.51
|
| Rate for Payer: PACE SWMI |
$57.38
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: PHP Medicare Advantage |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Medicare |
$57.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.38
|
| Rate for Payer: UHC Exchange |
$57.38
|
| Rate for Payer: UHC Medicare Advantage |
$57.38
|
| Rate for Payer: VA VA |
$57.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna Medicare |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.69
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$209.64
|
| Rate for Payer: BCN Commercial |
$198.26
|
| Rate for Payer: BCN Medicare Advantage |
$63.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.75
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: PACE Senior Care Partners |
$60.56
|
| Rate for Payer: PACE SWMI |
$63.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: PHP Medicare Advantage |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO |
$221.85
|
| Rate for Payer: Priority Health Medicare |
$64.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.85
|
| Rate for Payer: Railroad Medicare Medicare |
$63.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.40
|
| Rate for Payer: UHC Core |
$212.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.75
|
| Rate for Payer: UHC Exchange |
$63.75
|
| Rate for Payer: UHC Medicare Advantage |
$63.75
|
| Rate for Payer: VA VA |
$63.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $250
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: BCBS Trust/PPO |
$208.16
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO |
$221.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.40
|
| Rate for Payer: UHC Core |
$212.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$230.60
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Exchange |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$70.12
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z SLEEVE OR GLOVE EA $275
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: BCBS Trust/PPO |
$228.97
|
| Rate for Payer: BCN Commercial |
$216.77
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$249.79
|
| Rate for Payer: BCN Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO |
$266.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $300
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.62
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$251.56
|
| Rate for Payer: BCN Commercial |
$237.92
|
| Rate for Payer: BCN Medicare Advantage |
$76.50
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.50
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: PACE Senior Care Partners |
$72.68
|
| Rate for Payer: PACE SWMI |
$76.50
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO |
$266.22
|
| Rate for Payer: Priority Health Medicare |
$77.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.02
|
| Rate for Payer: Railroad Medicare Medicare |
$76.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.50
|
| Rate for Payer: UHC Exchange |
$76.50
|
| Rate for Payer: UHC Medicare Advantage |
$76.50
|
| Rate for Payer: VA VA |
$76.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
IP
|
$331.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.48 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: BCBS Trust/PPO |
$270.60
|
| Rate for Payer: BCN Commercial |
$256.18
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: Nomi Health Commercial |
$271.83
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health HMO/PPO |
$288.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.72
|
| Rate for Payer: UHC Core |
$276.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
|
HC OT Z SLEEVE OR GLOVE EA $325
|
Facility
|
OP
|
$331.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000036
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna Medicare |
$86.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.59
|
| Rate for Payer: BCBS Complete |
$132.60
|
| Rate for Payer: BCBS MAPPO |
$82.88
|
| Rate for Payer: BCBS Trust/PPO |
$272.53
|
| Rate for Payer: BCN Commercial |
$257.74
|
| Rate for Payer: BCN Medicare Advantage |
$82.88
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.88
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: Nomi Health Commercial |
$271.83
|
| Rate for Payer: PACE Senior Care Partners |
$78.73
|
| Rate for Payer: PACE SWMI |
$82.88
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: PHP Medicare Advantage |
$82.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health HMO/PPO |
$288.40
|
| Rate for Payer: Priority Health Medicare |
$83.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.10
|
| Rate for Payer: Railroad Medicare Medicare |
$82.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.72
|
| Rate for Payer: UHC Core |
$276.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.88
|
| Rate for Payer: UHC Exchange |
$82.88
|
| Rate for Payer: UHC Medicare Advantage |
$82.88
|
| Rate for Payer: VA VA |
$82.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: BCBS Trust/PPO |
$291.42
|
| Rate for Payer: BCN Commercial |
$275.89
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: Nomi Health Commercial |
$292.74
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO |
$310.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.16
|
| Rate for Payer: UHC Core |
$298.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $350
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.56
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$293.49
|
| Rate for Payer: BCN Commercial |
$277.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.25
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.25
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: Nomi Health Commercial |
$292.74
|
| Rate for Payer: PACE Senior Care Partners |
$84.79
|
| Rate for Payer: PACE SWMI |
$89.25
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: PHP Medicare Advantage |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO |
$310.59
|
| Rate for Payer: Priority Health Medicare |
$90.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.19
|
| Rate for Payer: Railroad Medicare Medicare |
$89.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.16
|
| Rate for Payer: UHC Core |
$298.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.25
|
| Rate for Payer: UHC Exchange |
$89.25
|
| Rate for Payer: UHC Medicare Advantage |
$89.25
|
| Rate for Payer: VA VA |
$89.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.75
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
OP
|
$382.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna Medicare |
$99.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.53
|
| Rate for Payer: BCBS Complete |
$153.00
|
| Rate for Payer: BCBS MAPPO |
$95.62
|
| Rate for Payer: BCBS Trust/PPO |
$314.45
|
| Rate for Payer: BCN Commercial |
$297.39
|
| Rate for Payer: BCN Medicare Advantage |
$95.62
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.62
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: PACE Senior Care Partners |
$90.84
|
| Rate for Payer: PACE SWMI |
$95.62
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: PHP Medicare Advantage |
$95.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health HMO/PPO |
$332.78
|
| Rate for Payer: Priority Health Medicare |
$96.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.28
|
| Rate for Payer: Railroad Medicare Medicare |
$95.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.60
|
| Rate for Payer: UHC Core |
$319.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.62
|
| Rate for Payer: UHC Exchange |
$95.62
|
| Rate for Payer: UHC Medicare Advantage |
$95.62
|
| Rate for Payer: VA VA |
$95.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
IP
|
$382.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$248.62 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: BCBS Trust/PPO |
$312.23
|
| Rate for Payer: BCN Commercial |
$295.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health HMO/PPO |
$332.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.60
|
| Rate for Payer: UHC Core |
$319.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$33.54
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.20
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna Medicare |
$106.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.50
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$335.42
|
| Rate for Payer: BCN Commercial |
$317.22
|
| Rate for Payer: BCN Medicare Advantage |
$102.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: PACE Senior Care Partners |
$96.90
|
| Rate for Payer: PACE SWMI |
$102.00
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: PHP Medicare Advantage |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO |
$354.96
|
| Rate for Payer: Priority Health Medicare |
$103.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.36
|
| Rate for Payer: Railroad Medicare Medicare |
$102.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.00
|
| Rate for Payer: UHC Exchange |
$102.00
|
| Rate for Payer: UHC Medicare Advantage |
$102.00
|
| Rate for Payer: VA VA |
$102.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: BCBS Trust/PPO |
$333.05
|
| Rate for Payer: BCN Commercial |
$315.30
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: Nomi Health Commercial |
$334.56
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO |
$354.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: Aetna Medicare |
$112.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.47
|
| Rate for Payer: BCBS Complete |
$173.40
|
| Rate for Payer: BCBS MAPPO |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$356.38
|
| Rate for Payer: BCN Commercial |
$337.05
|
| Rate for Payer: BCN Medicare Advantage |
$108.38
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.38
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: PACE Senior Care Partners |
$102.96
|
| Rate for Payer: PACE SWMI |
$108.38
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: PHP Medicare Advantage |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health HMO/PPO |
$377.14
|
| Rate for Payer: Priority Health Medicare |
$109.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.44
|
| Rate for Payer: Railroad Medicare Medicare |
$108.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.48
|
| Rate for Payer: UHC Core |
$361.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.38
|
| Rate for Payer: UHC Exchange |
$108.38
|
| Rate for Payer: UHC Medicare Advantage |
$108.38
|
| Rate for Payer: VA VA |
$108.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.78 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: BCBS Trust/PPO |
$353.87
|
| Rate for Payer: BCN Commercial |
$335.01
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: Nomi Health Commercial |
$355.47
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health HMO/PPO |
$377.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.48
|
| Rate for Payer: UHC Core |
$361.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
