|
HC OT Z STOCKINGS NON CUSTOM $225
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: Aetna Medicare |
$86.61
|
| Rate for Payer: ASR ASR |
$227.07
|
| Rate for Payer: BCBS Complete |
$93.64
|
| Rate for Payer: BCBS Trust/PPO |
$193.01
|
| Rate for Payer: BCN Commercial |
$193.01
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$220.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$227.07
|
| Rate for Payer: Healthscope Whirlpool |
$234.09
|
| Rate for Payer: Mclaren Commercial |
$210.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.11
|
| Rate for Payer: Priority Health Narrow Network |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $250
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.24 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: Aetna Medicare |
$96.24
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: BCBS Complete |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$214.45
|
| Rate for Payer: BCN Commercial |
$214.45
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$252.30
|
| Rate for Payer: Healthscope Whirlpool |
$260.10
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.90
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC OT Z STOCKINGS NON CUSTOM $250
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.07 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: BCBS Trust/PPO |
$213.59
|
| Rate for Payer: BCN Commercial |
$213.59
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$252.30
|
| Rate for Payer: Healthscope Whirlpool |
$260.10
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC OT Z STOCKINGS NON CUSTOM $275
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$105.86
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$235.90
|
| Rate for Payer: BCN Commercial |
$235.90
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC OT Z STOCKINGS NON CUSTOM $275
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$234.95
|
| Rate for Payer: BCN Commercial |
$234.95
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$277.53
|
| Rate for Payer: Healthscope Whirlpool |
$286.11
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC OT Z STOCKINGS NON CUSTOM $300
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Complete |
$124.85
|
| Rate for Payer: BCBS Trust/PPO |
$257.34
|
| Rate for Payer: BCN Commercial |
$257.34
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC OT Z STOCKINGS NON CUSTOM $300
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300123
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$256.31
|
| Rate for Payer: BCN Commercial |
$256.31
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC OT Z STOCKINGS NON CUSTOM $325
|
Facility
|
OP
|
$338.13
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$338.13 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: Aetna Medicare |
$125.11
|
| Rate for Payer: ASR ASR |
$327.99
|
| Rate for Payer: BCBS Complete |
$135.25
|
| Rate for Payer: BCBS Trust/PPO |
$278.79
|
| Rate for Payer: BCN Commercial |
$278.79
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$317.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Healthscope Commercial |
$327.99
|
| Rate for Payer: Healthscope Whirlpool |
$338.13
|
| Rate for Payer: Mclaren Commercial |
$304.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Nomi Health Commercial |
$277.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.27
|
| Rate for Payer: Priority Health Narrow Network |
$237.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.55
|
|
|
HC OT Z STOCKINGS NON CUSTOM $325
|
Facility
|
IP
|
$338.13
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$338.13 |
| Rate for Payer: Aetna Commercial |
$304.32
|
| Rate for Payer: ASR ASR |
$327.99
|
| Rate for Payer: BCBS Trust/PPO |
$277.67
|
| Rate for Payer: BCN Commercial |
$277.67
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$317.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Healthscope Commercial |
$327.99
|
| Rate for Payer: Healthscope Whirlpool |
$338.13
|
| Rate for Payer: Mclaren Commercial |
$304.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Nomi Health Commercial |
$277.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.55
|
|
|
HC OT Z STOCKINGS NON CUSTOM $350
|
Facility
|
OP
|
$364.14
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$364.14 |
| Rate for Payer: Aetna Commercial |
$327.73
|
| Rate for Payer: Aetna Medicare |
$134.73
|
| Rate for Payer: ASR ASR |
$353.22
|
| Rate for Payer: BCBS Complete |
$145.66
|
| Rate for Payer: BCBS Trust/PPO |
$300.23
|
| Rate for Payer: BCN Commercial |
$300.23
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.31
|
| Rate for Payer: Healthscope Commercial |
$353.22
|
| Rate for Payer: Healthscope Whirlpool |
$364.14
|
| Rate for Payer: Mclaren Commercial |
$327.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.52
|
| Rate for Payer: Nomi Health Commercial |
$298.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$319.06
|
| Rate for Payer: Priority Health Narrow Network |
$255.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.44
|
|
|
HC OT Z STOCKINGS NON CUSTOM $350
|
Facility
|
IP
|
$364.14
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$273.11 |
| Max. Negotiated Rate |
$364.14 |
| Rate for Payer: Aetna Commercial |
$327.73
|
| Rate for Payer: ASR ASR |
$353.22
|
| Rate for Payer: BCBS Trust/PPO |
$299.03
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.31
|
| Rate for Payer: Healthscope Commercial |
$353.22
|
| Rate for Payer: Healthscope Whirlpool |
$364.14
|
| Rate for Payer: Mclaren Commercial |
$327.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.52
|
| Rate for Payer: Nomi Health Commercial |
$298.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.44
|
|
|
HC OT Z STOCKINGS NON CUSTOM $375
|
Facility
|
OP
|
$390.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.13
|
| Rate for Payer: Aetna Medicare |
$144.36
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: BCBS Complete |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$321.68
|
| Rate for Payer: BCN Commercial |
$321.68
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$378.45
|
| Rate for Payer: Healthscope Whirlpool |
$390.15
|
| Rate for Payer: Mclaren Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.85
|
| Rate for Payer: Priority Health Narrow Network |
$273.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
|
|
HC OT Z STOCKINGS NON CUSTOM $375
|
Facility
|
IP
|
$390.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.61 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.13
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: BCBS Trust/PPO |
$320.39
|
| Rate for Payer: BCN Commercial |
$320.39
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$378.45
|
| Rate for Payer: Healthscope Whirlpool |
$390.15
|
| Rate for Payer: Mclaren Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
|
|
HC OT Z STOCKINGS NON CUSTOM $40
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.32
|
| Rate for Payer: BCN Commercial |
$34.32
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC OT Z STOCKINGS NON CUSTOM $40
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$40.37
|
| Rate for Payer: Healthscope Whirlpool |
$41.62
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC OT Z STOCKINGS NON CUSTOM $400
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.12 |
| Max. Negotiated Rate |
$416.16 |
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: ASR ASR |
$403.68
|
| Rate for Payer: BCBS Trust/PPO |
$341.75
|
| Rate for Payer: BCN Commercial |
$341.75
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$403.68
|
| Rate for Payer: Healthscope Whirlpool |
$416.16
|
| Rate for Payer: Mclaren Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.22
|
|
|
HC OT Z STOCKINGS NON CUSTOM $400
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.98 |
| Max. Negotiated Rate |
$416.16 |
| Rate for Payer: Aetna Commercial |
$374.54
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: ASR ASR |
$403.68
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$343.12
|
| Rate for Payer: BCN Commercial |
$343.12
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$403.68
|
| Rate for Payer: Healthscope Whirlpool |
$416.16
|
| Rate for Payer: Mclaren Commercial |
$374.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Nomi Health Commercial |
$341.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$364.64
|
| Rate for Payer: Priority Health Narrow Network |
$291.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.22
|
|
|
HC OT Z STOCKINGS NON CUSTOM $425
|
Facility
|
IP
|
$442.17
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$331.63 |
| Max. Negotiated Rate |
$442.17 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: ASR ASR |
$428.90
|
| Rate for Payer: BCBS Trust/PPO |
$363.11
|
| Rate for Payer: BCN Commercial |
$363.11
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Commercial |
$415.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$428.90
|
| Rate for Payer: Healthscope Whirlpool |
$442.17
|
| Rate for Payer: Mclaren Commercial |
$397.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Nomi Health Commercial |
$362.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.11
|
|
|
HC OT Z STOCKINGS NON CUSTOM $425
|
Facility
|
OP
|
$442.17
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$442.17 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$163.60
|
| Rate for Payer: ASR ASR |
$428.90
|
| Rate for Payer: BCBS Complete |
$176.87
|
| Rate for Payer: BCBS Trust/PPO |
$364.57
|
| Rate for Payer: BCN Commercial |
$364.57
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Commercial |
$415.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$428.90
|
| Rate for Payer: Healthscope Whirlpool |
$442.17
|
| Rate for Payer: Mclaren Commercial |
$397.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Nomi Health Commercial |
$362.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$387.43
|
| Rate for Payer: Priority Health Narrow Network |
$309.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.11
|
|
|
HC OT Z STOCKINGS NON CUSTOM $450
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$173.23
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$386.01
|
| Rate for Payer: BCN Commercial |
$386.01
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$410.22
|
| Rate for Payer: Priority Health Narrow Network |
$328.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $450
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Trust/PPO |
$384.47
|
| Rate for Payer: BCN Commercial |
$384.47
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC OT Z STOCKINGS NON CUSTOM $50
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$19.25
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.89
|
| Rate for Payer: BCN Commercial |
$42.89
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC OT Z STOCKINGS NON CUSTOM $50
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.72
|
| Rate for Payer: BCN Commercial |
$42.72
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$50.46
|
| Rate for Payer: Healthscope Whirlpool |
$52.02
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC OT Z STOCKINGS NON CUSTOM $60
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC OT Z STOCKINGS NON CUSTOM $60
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
