|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$374.68
|
| Rate for Payer: BCN Commercial |
$354.72
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$41.63
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.85
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$67.08
|
| Rate for Payer: BCN Commercial |
$63.44
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PACE Senior Care Partners |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Medicare |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.40
|
| Rate for Payer: UHC Exchange |
$20.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.40
|
| Rate for Payer: VA VA |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: BCBS Trust/PPO |
$66.61
|
| Rate for Payer: BCN Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$83.85
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.50
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $125
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC OT Z STOCKINGS CUSTOM EA $125
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$31.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$31.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.28
|
| Rate for Payer: PACE SWMI |
$31.88
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Medicare |
$32.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.88
|
| Rate for Payer: UHC Exchange |
$31.88
|
| Rate for Payer: UHC Medicare Advantage |
$31.88
|
| Rate for Payer: VA VA |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC OT Z STOCKINGS CUSTOM EA $150
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC OT Z STOCKINGS CUSTOM EA $150
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC OT Z STOCKINGS CUSTOM EA $175
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.78
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: BCBS MAPPO |
$44.62
|
| Rate for Payer: BCBS Trust/PPO |
$146.74
|
| Rate for Payer: BCN Commercial |
$138.78
|
| Rate for Payer: BCN Medicare Advantage |
$44.62
|
| 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: Health Alliance Plan Medicare Advantage |
$44.62
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: PACE Senior Care Partners |
$42.39
|
| Rate for Payer: PACE SWMI |
$44.62
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: PHP Medicare Advantage |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health HMO/PPO |
$155.30
|
| Rate for Payer: Priority Health Medicare |
$45.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.60
|
| Rate for Payer: Railroad Medicare Medicare |
$44.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.08
|
| Rate for Payer: UHC Core |
$149.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.62
|
| Rate for Payer: UHC Exchange |
$44.62
|
| Rate for Payer: UHC Medicare Advantage |
$44.62
|
| Rate for Payer: VA VA |
$44.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC OT Z STOCKINGS CUSTOM EA $175
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300097
|
|
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 STOCKINGS CUSTOM EA $200
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300098
|
|
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 STOCKINGS CUSTOM EA $200
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300098
|
|
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 STOCKINGS CUSTOM EA $225
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300099
|
|
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 STOCKINGS CUSTOM EA $225
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300099
|
|
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 STOCKINGS CUSTOM EA $250
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300100
|
|
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
|
|
