|
HC OT Z STOCKINGS NON CUSTOM $275
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| 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: 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 |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OT Z STOCKINGS NON CUSTOM $300
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $300
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $325
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna American Axle |
$211.25
|
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health SBD |
$204.75
|
| Rate for Payer: UMR Bronson Commercial |
$143.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $325
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$211.25
|
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health SBD |
$204.75
|
| Rate for Payer: UMR Bronson Commercial |
$120.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $350
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$129.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $350
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$154.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $375
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$243.75
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$138.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z STOCKINGS NON CUSTOM $375
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna American Axle |
$243.75
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$165.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z STOCKINGS NON CUSTOM $40
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $40
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $400
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$176.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $400
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$148.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $425
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$276.25
|
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.25
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health SBD |
$267.75
|
| Rate for Payer: UMR Bronson Commercial |
$157.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $425
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna American Axle |
$276.25
|
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.25
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health SBD |
$267.75
|
| Rate for Payer: UMR Bronson Commercial |
$187.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC OT Z STOCKINGS NON CUSTOM $450
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $450
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC OT Z STOCKINGS NON CUSTOM $50
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300131
|
|
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 NON CUSTOM $50
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300131
|
|
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 NON CUSTOM $60
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300132
|
|
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 NON CUSTOM $60
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300132
|
|
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 NON CUSTOM $70
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300133
|
|
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 NON CUSTOM $70
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300133
|
|
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 NON CUSTOM $80
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300134
|
|
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 NON CUSTOM $80
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300134
|
|
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
|
|
