|
HC OT Z STOCKINGS CUSTOM EA $50
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| 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 SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $50
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| 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 SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $60
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| 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 SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $60
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| 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 SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $70
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| 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 SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $70
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| 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 SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $80
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $80
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$35.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $90
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $90
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$33.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $100
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $100
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $125
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UMR Bronson Commercial |
$55.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $125
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UMR Bronson Commercial |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $150
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300117
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UMR Bronson Commercial |
$55.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $150
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300117
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UMR Bronson Commercial |
$66.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $175
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC OT Z STOCKINGS NON CUSTOM $175
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC OT Z STOCKINGS NON CUSTOM $200
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $200
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UMR Bronson Commercial |
$88.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $225
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UMR Bronson Commercial |
$83.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $225
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $250
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $250
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $275
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| 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 SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
