|
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
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: BCBS Trust/PPO |
$135.24
|
| Rate for Payer: BCN Commercial |
$135.24
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Core |
$146.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.69
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$43.75
|
| Rate for Payer: BCBS Trust/PPO |
$136.06
|
| Rate for Payer: BCN Commercial |
$136.06
|
| Rate for Payer: BCN Medicare Advantage |
$43.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.75
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PACE Senior Care Partners |
$41.56
|
| Rate for Payer: PACE SWMI |
$43.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Medicare Advantage |
$43.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health Medicare |
$43.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.73
|
| Rate for Payer: Railroad Medicare Medicare |
$43.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Core |
$146.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.06
|
| Rate for Payer: VA VA |
$43.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.98 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.56
|
| Rate for Payer: BCN Commercial |
$154.56
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$155.50
|
| Rate for Payer: BCN Commercial |
$155.50
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.98
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.00
|
| Rate for Payer: UHC Medicare Advantage |
$51.50
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.31
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$56.25
|
| Rate for Payer: BCBS Trust/PPO |
$174.94
|
| Rate for Payer: BCN Commercial |
$174.94
|
| Rate for Payer: BCN Medicare Advantage |
$56.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PACE Senior Care Partners |
$53.44
|
| Rate for Payer: PACE SWMI |
$56.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: PHP Medicare Advantage |
$56.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Medicare |
$56.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: Railroad Medicare Medicare |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.25
|
| Rate for Payer: UHC Medicare Advantage |
$57.94
|
| Rate for Payer: VA VA |
$56.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.23 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: BCBS Trust/PPO |
$173.88
|
| Rate for Payer: BCN Commercial |
$173.88
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.48 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: BCBS Trust/PPO |
$193.20
|
| Rate for Payer: BCN Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.38 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.12
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS MAPPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.38
|
| Rate for Payer: BCN Commercial |
$194.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Senior Care Partners |
$59.38
|
| Rate for Payer: PACE SWMI |
$62.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$62.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Medicare |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: Railroad Medicare Medicare |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$62.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.52
|
| Rate for Payer: BCN Commercial |
$212.52
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.81
|
| Rate for Payer: BCN Commercial |
$213.81
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$70.81
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.97 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$231.84
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.25
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.22 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: BCBS Trust/PPO |
$251.16
|
| Rate for Payer: BCN Commercial |
$251.16
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.00
|
| Rate for Payer: UHC Core |
$271.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.19 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna Medicare |
$84.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.56
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$81.25
|
| Rate for Payer: BCBS Trust/PPO |
$252.69
|
| Rate for Payer: BCN Commercial |
$252.69
|
| Rate for Payer: BCN Medicare Advantage |
$81.25
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.25
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PACE Senior Care Partners |
$77.19
|
| Rate for Payer: PACE SWMI |
$81.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: PHP Medicare Advantage |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.75
|
| Rate for Payer: Priority Health Medicare |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.22
|
| Rate for Payer: Railroad Medicare Medicare |
$81.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.00
|
| Rate for Payer: UHC Core |
$271.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.25
|
| Rate for Payer: UHC Medicare Advantage |
$83.69
|
| Rate for Payer: VA VA |
$81.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC OT Z GAUNTLET EA $350
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.38
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$87.50
|
| Rate for Payer: BCBS Trust/PPO |
$272.12
|
| Rate for Payer: BCN Commercial |
$272.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PACE Senior Care Partners |
$83.12
|
| Rate for Payer: PACE SWMI |
$87.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: PHP Medicare Advantage |
$87.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: Railroad Medicare Medicare |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.50
|
| Rate for Payer: UHC Medicare Advantage |
$90.12
|
| Rate for Payer: VA VA |
$87.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z GAUNTLET EA $350
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: BCBS Trust/PPO |
$270.48
|
| Rate for Payer: BCN Commercial |
$270.48
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC OT Z GAUNTLET EA $375
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.71 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: BCBS Trust/PPO |
$289.80
|
| Rate for Payer: BCN Commercial |
$289.80
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z GAUNTLET EA $375
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.19
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS MAPPO |
$93.75
|
| Rate for Payer: BCBS Trust/PPO |
$291.56
|
| Rate for Payer: BCN Commercial |
$291.56
|
| Rate for Payer: BCN Medicare Advantage |
$93.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.75
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PACE Senior Care Partners |
$89.06
|
| Rate for Payer: PACE SWMI |
$93.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Medicare Advantage |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: Railroad Medicare Medicare |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.75
|
| Rate for Payer: UHC Medicare Advantage |
$96.56
|
| Rate for Payer: VA VA |
$93.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC OT Z GAUNTLET EA $400
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.00
|
| Rate for Payer: BCN Commercial |
$311.00
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PACE Senior Care Partners |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.00
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.96
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.00
|
| Rate for Payer: UHC Core |
$334.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.00
|
| Rate for Payer: UHC Medicare Advantage |
$103.00
|
| Rate for Payer: VA VA |
$100.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z GAUNTLET EA $400
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$243.96 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: BCBS Trust/PPO |
$309.12
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.00
|
| Rate for Payer: UHC Core |
$334.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC OT Z GAUNTLET EA $425
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.21 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: BCBS Trust/PPO |
$328.44
|
| Rate for Payer: BCN Commercial |
$328.44
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.00
|
| Rate for Payer: UHC Core |
$354.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC OT Z GAUNTLET EA $425
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.81
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$330.44
|
| Rate for Payer: BCN Commercial |
$330.44
|
| Rate for Payer: BCN Medicare Advantage |
$106.25
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PACE Senior Care Partners |
$100.94
|
| Rate for Payer: PACE SWMI |
$106.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: PHP Medicare Advantage |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.75
|
| Rate for Payer: Priority Health Medicare |
$106.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.21
|
| Rate for Payer: Railroad Medicare Medicare |
$106.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.00
|
| Rate for Payer: UHC Core |
$354.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.25
|
| Rate for Payer: UHC Medicare Advantage |
$109.44
|
| Rate for Payer: VA VA |
$106.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
