|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
OP
|
$58.25
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$17.87
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$45.29
|
| Rate for Payer: BCN Commercial |
$45.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.69
|
| Rate for Payer: Mclaren Medicaid |
$17.02
|
| Rate for Payer: Meridian Medicaid |
$17.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.51
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.68
|
| Rate for Payer: Priority Health Medicare |
$14.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.53
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.26
|
| Rate for Payer: UHC Core |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$15.00
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.69
|
|
|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
IP
|
$58.25
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$45.02
|
| Rate for Payer: BCN Commercial |
$45.02
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.51
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.26
|
| Rate for Payer: UHC Core |
$48.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.69
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
OP
|
$59.54
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.61
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.61
|
| Rate for Payer: BCBS Complete |
$17.87
|
| Rate for Payer: BCBS MAPPO |
$14.88
|
| Rate for Payer: BCBS Trust/PPO |
$46.29
|
| Rate for Payer: BCN Commercial |
$46.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.88
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.88
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Mclaren Medicaid |
$17.02
|
| Rate for Payer: Meridian Medicaid |
$17.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.61
|
| Rate for Payer: PACE Senior Care Partners |
$14.14
|
| Rate for Payer: PACE SWMI |
$14.88
|
| Rate for Payer: PHP Commercial |
$50.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.80
|
| Rate for Payer: Priority Health Medicare |
$14.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.31
|
| Rate for Payer: Railroad Medicare Medicare |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.40
|
| Rate for Payer: UHC Core |
$49.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.88
|
| Rate for Payer: UHC Medicare Advantage |
$15.33
|
| Rate for Payer: VA VA |
$14.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
IP
|
$59.54
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.61
|
| Rate for Payer: BCBS Trust/PPO |
$46.01
|
| Rate for Payer: BCN Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.61
|
| Rate for Payer: PHP Commercial |
$50.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.40
|
| Rate for Payer: UHC Core |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
OP
|
$64.32
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.10
|
| Rate for Payer: BCBS Complete |
$17.87
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$50.01
|
| Rate for Payer: BCN Commercial |
$50.01
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Commercial |
$55.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.24
|
| Rate for Payer: Mclaren Medicaid |
$17.02
|
| Rate for Payer: Meridian Medicaid |
$17.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.67
|
| Rate for Payer: PACE Senior Care Partners |
$15.28
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Commercial |
$54.67
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.96
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.23
|
| Rate for Payer: Railroad Medicare Medicare |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.60
|
| Rate for Payer: UHC Core |
$53.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.56
|
| Rate for Payer: VA VA |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.24
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
IP
|
$64.32
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: BCBS Trust/PPO |
$49.71
|
| Rate for Payer: BCN Commercial |
$49.71
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Commercial |
$55.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.67
|
| Rate for Payer: PHP Commercial |
$54.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.60
|
| Rate for Payer: UHC Core |
$53.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.24
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
OP
|
$1,949.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.04 |
| Max. Negotiated Rate |
$1,754.68 |
| Rate for Payer: Aetna Commercial |
$1,657.20
|
| Rate for Payer: Aetna Medicare |
$506.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$609.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$609.27
|
| Rate for Payer: BCBS Complete |
$779.86
|
| Rate for Payer: BCBS MAPPO |
$487.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,515.85
|
| Rate for Payer: BCN Commercial |
$1,515.85
|
| Rate for Payer: BCN Medicare Advantage |
$487.41
|
| Rate for Payer: Cash Price |
$1,559.72
|
| Rate for Payer: Cofinity Commercial |
$1,676.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.41
|
| Rate for Payer: Healthscope Commercial |
$1,754.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,462.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$511.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$560.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,657.20
|
| Rate for Payer: PACE Senior Care Partners |
$463.04
|
| Rate for Payer: PACE SWMI |
$487.41
|
| Rate for Payer: PHP Commercial |
$1,657.20
|
| Rate for Payer: PHP Medicare Advantage |
$487.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,364.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,696.20
|
| Rate for Payer: Priority Health Medicare |
$487.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,189.09
|
| Rate for Payer: Railroad Medicare Medicare |
$487.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,715.69
|
| Rate for Payer: UHC Core |
$1,627.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.41
|
| Rate for Payer: UHC Medicare Advantage |
$502.03
|
| Rate for Payer: VA VA |
$487.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,462.24
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
IP
|
$1,949.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,189.09 |
| Max. Negotiated Rate |
$1,754.68 |
| Rate for Payer: Aetna Commercial |
$1,657.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,506.69
|
| Rate for Payer: BCN Commercial |
$1,506.69
|
| Rate for Payer: Cash Price |
$1,559.72
|
| Rate for Payer: Cofinity Commercial |
$1,676.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.72
|
| Rate for Payer: Healthscope Commercial |
$1,754.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,462.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,657.20
|
| Rate for Payer: PHP Commercial |
$1,657.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,364.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,696.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,189.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,715.69
|
| Rate for Payer: UHC Core |
$1,627.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,462.24
|
|
|
HC OSTO-ZYME
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Aetna Commercial |
$35.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.65
|
| Rate for Payer: BCN Commercial |
$32.65
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.80
|
| Rate for Payer: Healthscope Commercial |
$38.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.91
|
| Rate for Payer: PHP Commercial |
$35.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.18
|
| Rate for Payer: UHC Core |
$35.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.69
|
|
|
HC OSTO-ZYME
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Aetna Commercial |
$35.91
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.20
|
| Rate for Payer: BCBS Complete |
$16.90
|
| Rate for Payer: BCBS MAPPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$32.85
|
| Rate for Payer: BCN Commercial |
$32.85
|
| Rate for Payer: BCN Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$38.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.91
|
| Rate for Payer: PACE Senior Care Partners |
$10.03
|
| Rate for Payer: PACE SWMI |
$10.56
|
| Rate for Payer: PHP Commercial |
$35.91
|
| Rate for Payer: PHP Medicare Advantage |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.76
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.77
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.18
|
| Rate for Payer: UHC Core |
$35.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.56
|
| Rate for Payer: UHC Medicare Advantage |
$10.88
|
| Rate for Payer: VA VA |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.69
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$273.77
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$246.39 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: Aetna Medicare |
$71.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.55
|
| Rate for Payer: BCBS Complete |
$109.51
|
| Rate for Payer: BCBS MAPPO |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$212.86
|
| Rate for Payer: BCN Commercial |
$212.86
|
| Rate for Payer: BCN Medicare Advantage |
$68.44
|
| Rate for Payer: Cash Price |
$219.02
|
| Rate for Payer: Cofinity Commercial |
$235.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.44
|
| Rate for Payer: Healthscope Commercial |
$246.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.70
|
| Rate for Payer: PACE Senior Care Partners |
$65.02
|
| Rate for Payer: PACE SWMI |
$68.44
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: PHP Medicare Advantage |
$68.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.18
|
| Rate for Payer: Priority Health Medicare |
$68.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.97
|
| Rate for Payer: Railroad Medicare Medicare |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.92
|
| Rate for Payer: UHC Core |
$228.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.44
|
| Rate for Payer: UHC Medicare Advantage |
$70.50
|
| Rate for Payer: VA VA |
$68.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.33
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$273.77
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$166.97 |
| Max. Negotiated Rate |
$246.39 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: BCBS Trust/PPO |
$211.57
|
| Rate for Payer: BCN Commercial |
$211.57
|
| Rate for Payer: Cash Price |
$219.02
|
| Rate for Payer: Cofinity Commercial |
$235.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.02
|
| Rate for Payer: Healthscope Commercial |
$246.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.70
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.92
|
| Rate for Payer: UHC Core |
$228.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.33
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$223.99
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$136.61 |
| Max. Negotiated Rate |
$201.59 |
| Rate for Payer: Aetna Commercial |
$190.39
|
| Rate for Payer: BCBS Trust/PPO |
$173.10
|
| Rate for Payer: BCN Commercial |
$173.10
|
| Rate for Payer: Cash Price |
$179.19
|
| Rate for Payer: Cofinity Commercial |
$192.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.19
|
| Rate for Payer: Healthscope Commercial |
$201.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.39
|
| Rate for Payer: PHP Commercial |
$190.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.11
|
| Rate for Payer: UHC Core |
$187.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.99
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$223.99
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$201.59 |
| Rate for Payer: Aetna Commercial |
$190.39
|
| Rate for Payer: Aetna Medicare |
$58.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$174.15
|
| Rate for Payer: BCN Commercial |
$174.15
|
| Rate for Payer: BCN Medicare Advantage |
$56.00
|
| Rate for Payer: Cash Price |
$179.19
|
| Rate for Payer: Cofinity Commercial |
$192.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$201.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.39
|
| Rate for Payer: PACE Senior Care Partners |
$53.20
|
| Rate for Payer: PACE SWMI |
$56.00
|
| Rate for Payer: PHP Commercial |
$190.39
|
| Rate for Payer: PHP Medicare Advantage |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.87
|
| Rate for Payer: Priority Health Medicare |
$56.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.61
|
| Rate for Payer: Railroad Medicare Medicare |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.11
|
| Rate for Payer: UHC Core |
$187.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.00
|
| Rate for Payer: UHC Medicare Advantage |
$57.68
|
| Rate for Payer: VA VA |
$56.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.99
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$248.88
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$223.99 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: BCBS Trust/PPO |
$192.33
|
| Rate for Payer: BCN Commercial |
$192.33
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$214.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Healthscope Commercial |
$223.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.55
|
| Rate for Payer: PHP Commercial |
$211.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.01
|
| Rate for Payer: UHC Core |
$207.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.66
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$248.88
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$223.99 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: Aetna Medicare |
$64.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.78
|
| Rate for Payer: BCBS Complete |
$99.55
|
| Rate for Payer: BCBS MAPPO |
$62.22
|
| Rate for Payer: BCBS Trust/PPO |
$193.50
|
| Rate for Payer: BCN Commercial |
$193.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.22
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$214.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$223.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.55
|
| Rate for Payer: PACE Senior Care Partners |
$59.11
|
| Rate for Payer: PACE SWMI |
$62.22
|
| Rate for Payer: PHP Commercial |
$211.55
|
| Rate for Payer: PHP Medicare Advantage |
$62.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.53
|
| Rate for Payer: Priority Health Medicare |
$62.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.79
|
| Rate for Payer: Railroad Medicare Medicare |
$62.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.01
|
| Rate for Payer: UHC Core |
$207.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.22
|
| Rate for Payer: UHC Medicare Advantage |
$64.09
|
| Rate for Payer: VA VA |
$62.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.66
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: BCBS Trust/PPO |
$91.19
|
| Rate for Payer: BCN Commercial |
$91.19
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: Aetna Medicare |
$30.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.88
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$29.50
|
| Rate for Payer: BCBS Trust/PPO |
$91.74
|
| Rate for Payer: BCN Commercial |
$91.74
|
| Rate for Payer: BCN Medicare Advantage |
$29.50
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: PACE Senior Care Partners |
$28.02
|
| Rate for Payer: PACE SWMI |
$29.50
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: PHP Medicare Advantage |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health Medicare |
$29.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.97
|
| Rate for Payer: Railroad Medicare Medicare |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.38
|
| Rate for Payer: VA VA |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.25
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$25.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.75
|
| Rate for Payer: BCN Commercial |
$77.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PACE Senior Care Partners |
$23.75
|
| Rate for Payer: PACE SWMI |
$25.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Medicare Advantage |
$25.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.00
|
| Rate for Payer: Priority Health Medicare |
$25.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.99
|
| Rate for Payer: Railroad Medicare Medicare |
$25.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.00
|
| Rate for Payer: UHC Core |
$83.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.00
|
| Rate for Payer: UHC Medicare Advantage |
$25.75
|
| Rate for Payer: VA VA |
$25.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.99 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.28
|
| Rate for Payer: BCN Commercial |
$77.28
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.00
|
| Rate for Payer: UHC Core |
$83.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$97.19
|
| Rate for Payer: BCN Commercial |
$97.19
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.25
|
| Rate for Payer: UHC Medicare Advantage |
$32.19
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.60
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
