|
HC OT Z STOCKINGS CUSTOM EA $250
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300100
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$112.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC OT Z STOCKINGS CUSTOM EA $275
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$123.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z STOCKINGS CUSTOM EA $275
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$103.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z STOCKINGS CUSTOM EA $300
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna American Axle |
$198.90
|
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: UMR Bronson Commercial |
$134.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $300
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$198.90
|
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: UMR Bronson Commercial |
$113.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z STOCKINGS CUSTOM EA $325
|
Facility
|
IP
|
$331.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna American Axle |
$215.48
|
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health SBD |
$208.84
|
| Rate for Payer: UMR Bronson Commercial |
$145.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
|
HC OT Z STOCKINGS CUSTOM EA $325
|
Facility
|
OP
|
$331.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.66 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$215.48
|
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna Medicare |
$165.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: BCBS Complete |
$132.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health SBD |
$208.84
|
| Rate for Payer: UMR Bronson Commercial |
$122.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
|
HC OT Z STOCKINGS CUSTOM EA $350
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$232.05
|
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.05
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$249.90
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health SBD |
$224.91
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.75
|
|
|
HC OT Z STOCKINGS CUSTOM EA $350
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna American Axle |
$232.05
|
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.05
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$249.90
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health SBD |
$224.91
|
| Rate for Payer: UMR Bronson Commercial |
$157.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.75
|
|
|
HC OT Z STOCKINGS CUSTOM EA $375
|
Facility
|
IP
|
$382.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna American Axle |
$248.62
|
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health SBD |
$240.98
|
| Rate for Payer: UMR Bronson Commercial |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC OT Z STOCKINGS CUSTOM EA $375
|
Facility
|
OP
|
$382.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$248.62
|
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna Medicare |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: BCBS Complete |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health SBD |
$240.98
|
| Rate for Payer: UMR Bronson Commercial |
$141.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC OT Z STOCKINGS CUSTOM EA $40
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC OT Z STOCKINGS CUSTOM EA $40
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC OT Z STOCKINGS CUSTOM EA $400
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna American Axle |
$265.20
|
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health SBD |
$257.04
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $400
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna American Axle |
$265.20
|
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health SBD |
$257.04
|
| Rate for Payer: UMR Bronson Commercial |
$179.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC OT Z STOCKINGS CUSTOM EA $425
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna American Axle |
$281.78
|
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.78
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$303.45
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health SBD |
$273.10
|
| Rate for Payer: UMR Bronson Commercial |
$190.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
|
HC OT Z STOCKINGS CUSTOM EA $425
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna American Axle |
$281.78
|
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: Aetna Medicare |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.78
|
| Rate for Payer: BCBS Complete |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$303.45
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health SBD |
$273.10
|
| Rate for Payer: UMR Bronson Commercial |
$160.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
|
HC OT Z STOCKINGS CUSTOM EA $450
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna American Axle |
$298.35
|
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: UMR Bronson Commercial |
$201.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC OT Z STOCKINGS CUSTOM EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$169.83 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna American Axle |
$298.35
|
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: UMR Bronson Commercial |
$169.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC OT Z STOCKINGS CUSTOM EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OT Z STOCKINGS CUSTOM EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OT Z STOCKINGS CUSTOM EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC OT Z STOCKINGS CUSTOM EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC OT Z STOCKINGS CUSTOM EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC OT Z STOCKINGS CUSTOM EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
