|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$258.94
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$233.05 |
| Rate for Payer: Aetna Commercial |
$220.10
|
| Rate for Payer: BCBS Trust/PPO |
$213.86
|
| Rate for Payer: BCN Commercial |
$213.86
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$222.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.15
|
| Rate for Payer: Healthscope Commercial |
$233.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.10
|
| Rate for Payer: Nomi Health Commercial |
$212.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.21
|
| Rate for Payer: PHP Commercial |
$220.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.87
|
| Rate for Payer: UHC Core |
$216.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.21
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$124.62
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.94
|
| Rate for Payer: BCBS Complete |
$23.07
|
| Rate for Payer: BCBS MAPPO |
$31.16
|
| Rate for Payer: BCBS Trust/PPO |
$102.45
|
| Rate for Payer: BCN Commercial |
$102.45
|
| Rate for Payer: BCN Medicare Advantage |
$31.16
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.47
|
| Rate for Payer: Mclaren Medicaid |
$21.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.71
|
| Rate for Payer: Meridian Medicaid |
$23.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.47
|
| Rate for Payer: PACE Senior Care Partners |
$29.60
|
| Rate for Payer: PACE SWMI |
$31.16
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: PHP Medicare Advantage |
$31.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.42
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.74
|
| Rate for Payer: Railroad Medicare Medicare |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.67
|
| Rate for Payer: UHC Core |
$104.06
|
| Rate for Payer: UHC Exchange |
$31.16
|
| Rate for Payer: UHC Medicaid |
$21.97
|
| Rate for Payer: UHC Medicare Advantage |
$31.16
|
| Rate for Payer: UHCCP Medicaid |
$21.97
|
| Rate for Payer: VA VA |
$31.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.47
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$124.62
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: BCBS Trust/PPO |
$102.92
|
| Rate for Payer: BCN Commercial |
$102.92
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.47
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.67
|
| Rate for Payer: UHC Core |
$104.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.47
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$19.26
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.53
|
| Rate for Payer: BCN Commercial |
$85.53
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: Meridian Medicaid |
$19.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.41
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Exchange |
$26.01
|
| Rate for Payer: UHC Medicaid |
$18.34
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$18.34
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$85.93
|
| Rate for Payer: BCN Commercial |
$85.93
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: BCBS Trust/PPO |
$107.41
|
| Rate for Payer: BCN Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.44
|
| Rate for Payer: UHC Core |
$108.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.64
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: BCBS MAPPO |
$32.51
|
| Rate for Payer: BCBS Trust/PPO |
$106.91
|
| Rate for Payer: BCN Commercial |
$106.91
|
| Rate for Payer: BCN Medicare Advantage |
$32.51
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.51
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: Mclaren Medicaid |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.14
|
| Rate for Payer: Meridian Medicaid |
$24.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PACE Senior Care Partners |
$30.89
|
| Rate for Payer: PACE SWMI |
$32.51
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: PHP Medicare Advantage |
$32.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.14
|
| Rate for Payer: Priority Health Medicare |
$32.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.51
|
| Rate for Payer: Railroad Medicare Medicare |
$32.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.44
|
| Rate for Payer: UHC Core |
$108.59
|
| Rate for Payer: UHC Exchange |
$32.51
|
| Rate for Payer: UHC Medicaid |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$32.51
|
| Rate for Payer: UHCCP Medicaid |
$22.93
|
| Rate for Payer: VA VA |
$32.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$128.89
|
| Rate for Payer: BCN Commercial |
$128.89
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$28.89
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$128.30
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Mclaren Medicaid |
$27.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: Meridian Medicaid |
$28.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicaid |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: UHCCP Medicaid |
$27.51
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna Medicare |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.90
|
| Rate for Payer: BCBS Complete |
$33.70
|
| Rate for Payer: BCBS MAPPO |
$45.52
|
| Rate for Payer: BCBS Trust/PPO |
$149.68
|
| Rate for Payer: BCN Commercial |
$149.68
|
| Rate for Payer: BCN Medicare Advantage |
$45.52
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.52
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: Mclaren Medicaid |
$32.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.79
|
| Rate for Payer: Meridian Medicaid |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PACE Senior Care Partners |
$43.24
|
| Rate for Payer: PACE SWMI |
$45.52
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: PHP Medicare Advantage |
$45.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.40
|
| Rate for Payer: Priority Health Medicare |
$45.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.72
|
| Rate for Payer: Railroad Medicare Medicare |
$45.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.22
|
| Rate for Payer: UHC Core |
$152.03
|
| Rate for Payer: UHC Exchange |
$45.52
|
| Rate for Payer: UHC Medicaid |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$45.52
|
| Rate for Payer: UHCCP Medicaid |
$32.10
|
| Rate for Payer: VA VA |
$45.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: BCBS Trust/PPO |
$150.37
|
| Rate for Payer: BCN Commercial |
$150.37
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.22
|
| Rate for Payer: UHC Core |
$152.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.19
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: BCBS Trust/PPO |
$171.85
|
| Rate for Payer: BCN Commercial |
$171.85
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.11
|
| Rate for Payer: UHC Core |
$173.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: Aetna Medicare |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.03
|
| Rate for Payer: BCBS Complete |
$38.52
|
| Rate for Payer: BCBS MAPPO |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.06
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: BCN Medicare Advantage |
$52.02
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$36.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.62
|
| Rate for Payer: Meridian Medicaid |
$38.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: PACE Senior Care Partners |
$49.42
|
| Rate for Payer: PACE SWMI |
$52.02
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: PHP Medicare Advantage |
$52.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.03
|
| Rate for Payer: Priority Health Medicare |
$52.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.82
|
| Rate for Payer: Railroad Medicare Medicare |
$52.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.11
|
| Rate for Payer: UHC Core |
$173.75
|
| Rate for Payer: UHC Exchange |
$52.02
|
| Rate for Payer: UHC Medicaid |
$36.68
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
| Rate for Payer: UHCCP Medicaid |
$36.68
|
| Rate for Payer: VA VA |
$52.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna Medicare |
$60.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.15
|
| Rate for Payer: BCBS Complete |
$43.33
|
| Rate for Payer: BCBS MAPPO |
$58.52
|
| Rate for Payer: BCBS Trust/PPO |
$192.45
|
| Rate for Payer: BCN Commercial |
$192.45
|
| Rate for Payer: BCN Medicare Advantage |
$58.52
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.52
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Mclaren Medicaid |
$41.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.45
|
| Rate for Payer: Meridian Medicaid |
$43.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.37
|
| 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: PACE Senior Care Partners |
$55.60
|
| Rate for Payer: PACE SWMI |
$58.52
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: PHP Medicare Advantage |
$58.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$203.66
|
| Rate for Payer: Priority Health Medicare |
$59.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.93
|
| Rate for Payer: Railroad Medicare Medicare |
$58.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.00
|
| Rate for Payer: UHC Core |
$195.47
|
| Rate for Payer: UHC Exchange |
$58.52
|
| Rate for Payer: UHC Medicaid |
$41.27
|
| Rate for Payer: UHC Medicare Advantage |
$58.52
|
| Rate for Payer: UHCCP Medicaid |
$41.27
|
| Rate for Payer: VA VA |
$58.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
IP
|
$234.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.93 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: BCBS Trust/PPO |
$193.33
|
| Rate for Payer: BCN Commercial |
$193.33
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| 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: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$203.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.00
|
| Rate for Payer: UHC Core |
$195.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.28
|
| Rate for Payer: BCBS Complete |
$48.14
|
| Rate for Payer: BCBS MAPPO |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$213.83
|
| Rate for Payer: BCN Commercial |
$213.83
|
| Rate for Payer: BCN Medicare Advantage |
$65.03
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.03
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.28
|
| Rate for Payer: Meridian Medicaid |
$48.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.53
|
| 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: PACE Senior Care Partners |
$61.77
|
| Rate for Payer: PACE SWMI |
$65.03
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: PHP Medicare Advantage |
$65.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.29
|
| Rate for Payer: Priority Health Medicare |
$65.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.03
|
| Rate for Payer: Railroad Medicare Medicare |
$65.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.89
|
| Rate for Payer: UHC Core |
$217.18
|
| Rate for Payer: UHC Exchange |
$65.03
|
| Rate for Payer: UHC Medicaid |
$45.86
|
| Rate for Payer: UHC Medicare Advantage |
$65.03
|
| Rate for Payer: UHCCP Medicaid |
$45.86
|
| Rate for Payer: VA VA |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$181.03 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: BCBS Trust/PPO |
$214.82
|
| Rate for Payer: BCN Commercial |
$214.82
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| 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: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.89
|
| Rate for Payer: UHC Core |
$217.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$52.96
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$235.21
|
| Rate for Payer: BCN Commercial |
$235.21
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Mclaren Medicaid |
$50.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Meridian Medicaid |
$52.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.68
|
| 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: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.13
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicaid |
$50.44
|
| Rate for Payer: UHC Medicare Advantage |
$71.53
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.13 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: BCBS Trust/PPO |
$236.30
|
| Rate for Payer: BCN Commercial |
$236.30
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| 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: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$57.77
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$256.59
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$57.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.83
|
| 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: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicaid |
$55.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$55.03
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$217.24 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$257.78
|
| Rate for Payer: BCN Commercial |
$257.78
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| 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: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
OP
|
$338.13
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$287.41
|
| Rate for Payer: Aetna Medicare |
$87.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.67
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$84.53
|
| Rate for Payer: BCBS Trust/PPO |
$277.98
|
| Rate for Payer: BCN Commercial |
$277.98
|
| Rate for Payer: BCN Medicare Advantage |
$84.53
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$290.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.53
|
| Rate for Payer: Healthscope Commercial |
$304.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.60
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.76
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.99
|
| 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: PACE Senior Care Partners |
$80.31
|
| Rate for Payer: PACE SWMI |
$84.53
|
| Rate for Payer: PHP Commercial |
$287.41
|
| Rate for Payer: PHP Medicare Advantage |
$84.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.17
|
| Rate for Payer: Priority Health Medicare |
$85.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.34
|
| Rate for Payer: Railroad Medicare Medicare |
$84.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.55
|
| Rate for Payer: UHC Core |
$282.34
|
| Rate for Payer: UHC Exchange |
$84.53
|
| Rate for Payer: UHC Medicaid |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$84.53
|
| Rate for Payer: UHCCP Medicaid |
$59.61
|
| Rate for Payer: VA VA |
$84.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.60
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
IP
|
$338.13
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$235.34 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$287.41
|
| Rate for Payer: BCBS Trust/PPO |
$279.26
|
| Rate for Payer: BCN Commercial |
$279.26
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Commercial |
$290.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.50
|
| Rate for Payer: Healthscope Commercial |
$304.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.60
|
| 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: PHP Commercial |
$287.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.55
|
| Rate for Payer: UHC Core |
$282.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.60
|
|
