|
HC OT Z SLEEVE OR GLOVE EA $375
|
Facility
|
OP
|
$390.15
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$253.60
|
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna Medicare |
$195.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: BCBS Complete |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.60
|
| Rate for Payer: UHC Core |
$203.27
|
| Rate for Payer: UHC Exchange |
$153.33
|
| Rate for Payer: UMR Bronson Commercial |
$144.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.61
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC OT Z SLEEVE OR GLOVE EA $40
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.05
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.11 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna American Axle |
$270.50
|
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Advantage |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health SBD |
$262.18
|
| Rate for Payer: UMR Bronson Commercial |
$183.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC OT Z SLEEVE OR GLOVE EA $400
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.98 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$270.50
|
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna Medicare |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Advantage |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health SBD |
$262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.50
|
| Rate for Payer: UHC Core |
$216.82
|
| Rate for Payer: UHC Exchange |
$163.55
|
| Rate for Payer: UMR Bronson Commercial |
$153.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
IP
|
$442.17
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$397.95 |
| Rate for Payer: Aetna American Axle |
$287.41
|
| Rate for Payer: Aetna Commercial |
$375.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.41
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Advantage |
$309.52
|
| Rate for Payer: Cofinity Commercial |
$380.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$397.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: PHP Commercial |
$375.84
|
| Rate for Payer: Priority Health SBD |
$278.57
|
| Rate for Payer: UMR Bronson Commercial |
$194.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.63
|
|
|
HC OT Z SLEEVE OR GLOVE EA $425
|
Facility
|
OP
|
$442.17
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$287.41
|
| Rate for Payer: Aetna Commercial |
$375.84
|
| Rate for Payer: Aetna Medicare |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.41
|
| Rate for Payer: BCBS Complete |
$176.87
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Advantage |
$309.52
|
| Rate for Payer: Cofinity Commercial |
$380.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$397.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: PHP Commercial |
$375.84
|
| Rate for Payer: Priority Health SBD |
$278.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.41
|
| Rate for Payer: UHC Core |
$230.37
|
| Rate for Payer: UHC Exchange |
$173.77
|
| Rate for Payer: UMR Bronson Commercial |
$163.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.63
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.32
|
| Rate for Payer: UHC Core |
$243.92
|
| Rate for Payer: UHC Exchange |
$183.99
|
| Rate for Payer: UMR Bronson Commercial |
$173.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC OT Z SLEEVE OR GLOVE EA $450
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UMR Bronson Commercial |
$206.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC OT Z SLEEVE OR GLOVE EA $50
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.81
|
| Rate for Payer: UHC Core |
$27.10
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC OT Z SLEEVE OR GLOVE EA $60
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC OT Z SLEEVE OR GLOVE EA $70
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.10
|
| Rate for Payer: UHC Core |
$43.36
|
| Rate for Payer: UHC Exchange |
$32.71
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC OT Z SLEEVE OR GLOVE EA $80
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UMR Bronson Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC OT Z SLEEVE OR GLOVE EA $90
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$651.48 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$651.48
|
| Rate for Payer: BCN Commercial |
$651.48
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$48.79
|
| Rate for Payer: UHC Exchange |
$36.80
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.63
|
| Rate for Payer: UHC Core |
$54.20
|
| Rate for Payer: UHC Exchange |
$40.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC OT Z STOCKINGS CUSTOM EA $100
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$45.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC OT Z STOCKINGS CUSTOM EA $125
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UMR Bronson Commercial |
$57.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC OT Z STOCKINGS CUSTOM EA $125
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
| Rate for Payer: UMR Bronson Commercial |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC OT Z STOCKINGS CUSTOM EA $150
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.44
|
| Rate for Payer: UHC Core |
$81.31
|
| Rate for Payer: UHC Exchange |
$61.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC OT Z STOCKINGS CUSTOM EA $150
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UMR Bronson Commercial |
$68.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
