|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
IP
|
$59.42
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$53.48 |
| Rate for Payer: Aetna Commercial |
$50.51
|
| Rate for Payer: BCBS Trust/PPO |
$48.50
|
| Rate for Payer: BCN Commercial |
$45.92
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$53.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.51
|
| Rate for Payer: Nomi Health Commercial |
$48.72
|
| Rate for Payer: PHP Commercial |
$50.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: Priority Health HMO/PPO |
$51.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.29
|
| Rate for Payer: UHC Core |
$49.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.56
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
IP
|
$60.73
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$51.62
|
| Rate for Payer: BCBS Trust/PPO |
$49.57
|
| Rate for Payer: BCN Commercial |
$46.93
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cofinity Commercial |
$52.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.58
|
| Rate for Payer: Healthscope Commercial |
$54.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.62
|
| Rate for Payer: Nomi Health Commercial |
$49.80
|
| Rate for Payer: PHP Commercial |
$51.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.47
|
| Rate for Payer: Priority Health HMO/PPO |
$52.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.44
|
| Rate for Payer: UHC Core |
$50.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.55
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
OP
|
$60.73
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Aetna Commercial |
$51.62
|
| Rate for Payer: Aetna Medicare |
$15.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.98
|
| Rate for Payer: BCBS Complete |
$19.21
|
| Rate for Payer: BCBS MAPPO |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$49.93
|
| Rate for Payer: BCN Commercial |
$47.22
|
| Rate for Payer: BCN Medicare Advantage |
$15.18
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cofinity Commercial |
$52.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$54.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.55
|
| Rate for Payer: Mclaren Medicaid |
$18.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.94
|
| Rate for Payer: Meridian Medicaid |
$19.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.62
|
| Rate for Payer: Nomi Health Commercial |
$49.80
|
| Rate for Payer: PACE Senior Care Partners |
$14.42
|
| Rate for Payer: PACE SWMI |
$15.18
|
| Rate for Payer: PHP Commercial |
$51.62
|
| Rate for Payer: PHP Medicare Advantage |
$15.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.47
|
| Rate for Payer: Priority Health HMO/PPO |
$52.84
|
| Rate for Payer: Priority Health Medicare |
$15.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.69
|
| Rate for Payer: Railroad Medicare Medicare |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.44
|
| Rate for Payer: UHC Core |
$50.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.18
|
| Rate for Payer: UHC Exchange |
$15.18
|
| Rate for Payer: UHC Medicare Advantage |
$15.18
|
| Rate for Payer: UHCCP Medicaid |
$18.29
|
| Rate for Payer: VA VA |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.55
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
IP
|
$65.61
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$59.05 |
| Rate for Payer: Aetna Commercial |
$55.77
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCN Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cofinity Commercial |
$56.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.49
|
| Rate for Payer: Healthscope Commercial |
$59.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.77
|
| Rate for Payer: Nomi Health Commercial |
$53.80
|
| Rate for Payer: PHP Commercial |
$55.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.65
|
| Rate for Payer: Priority Health HMO/PPO |
$57.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.74
|
| Rate for Payer: UHC Core |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.21
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
OP
|
$65.61
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$59.05 |
| Rate for Payer: Aetna Commercial |
$55.77
|
| Rate for Payer: Aetna Medicare |
$17.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.50
|
| Rate for Payer: BCBS Complete |
$19.21
|
| Rate for Payer: BCBS MAPPO |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$53.94
|
| Rate for Payer: BCN Commercial |
$51.01
|
| Rate for Payer: BCN Medicare Advantage |
$16.40
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cofinity Commercial |
$56.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$59.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.21
|
| Rate for Payer: Mclaren Medicaid |
$18.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.22
|
| Rate for Payer: Meridian Medicaid |
$19.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.77
|
| Rate for Payer: Nomi Health Commercial |
$53.80
|
| Rate for Payer: PACE Senior Care Partners |
$15.58
|
| Rate for Payer: PACE SWMI |
$16.40
|
| Rate for Payer: PHP Commercial |
$55.77
|
| Rate for Payer: PHP Medicare Advantage |
$16.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.65
|
| Rate for Payer: Priority Health HMO/PPO |
$57.08
|
| Rate for Payer: Priority Health Medicare |
$16.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.96
|
| Rate for Payer: Railroad Medicare Medicare |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.74
|
| Rate for Payer: UHC Core |
$54.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.40
|
| Rate for Payer: UHC Exchange |
$16.40
|
| Rate for Payer: UHC Medicare Advantage |
$16.40
|
| Rate for Payer: UHCCP Medicaid |
$18.29
|
| Rate for Payer: VA VA |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.21
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
OP
|
$1,988.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.30 |
| Max. Negotiated Rate |
$1,789.78 |
| Rate for Payer: Aetna Commercial |
$1,690.34
|
| Rate for Payer: Aetna Medicare |
$517.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$621.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$621.45
|
| Rate for Payer: BCBS Complete |
$795.46
|
| Rate for Payer: BCBS MAPPO |
$497.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,634.86
|
| Rate for Payer: BCN Commercial |
$1,546.17
|
| Rate for Payer: BCN Medicare Advantage |
$497.16
|
| Rate for Payer: Cash Price |
$1,590.91
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.16
|
| Rate for Payer: Healthscope Commercial |
$1,789.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,690.34
|
| Rate for Payer: Nomi Health Commercial |
$1,630.68
|
| Rate for Payer: PACE Senior Care Partners |
$472.30
|
| Rate for Payer: PACE SWMI |
$497.16
|
| Rate for Payer: PHP Commercial |
$1,690.34
|
| Rate for Payer: PHP Medicare Advantage |
$497.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.62
|
| Rate for Payer: Priority Health HMO/PPO |
$1,730.12
|
| Rate for Payer: Priority Health Medicare |
$502.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,332.39
|
| Rate for Payer: Railroad Medicare Medicare |
$497.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.00
|
| Rate for Payer: UHC Core |
$1,660.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$497.16
|
| Rate for Payer: UHC Exchange |
$497.16
|
| Rate for Payer: UHC Medicare Advantage |
$497.16
|
| Rate for Payer: VA VA |
$497.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.48
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
IP
|
$1,988.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,292.62 |
| Max. Negotiated Rate |
$1,789.78 |
| Rate for Payer: Aetna Commercial |
$1,690.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.33
|
| Rate for Payer: BCN Commercial |
$1,536.82
|
| Rate for Payer: Cash Price |
$1,590.91
|
| Rate for Payer: Cofinity Commercial |
$1,710.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.91
|
| Rate for Payer: Healthscope Commercial |
$1,789.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,690.34
|
| Rate for Payer: Nomi Health Commercial |
$1,630.68
|
| Rate for Payer: PHP Commercial |
$1,690.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.62
|
| Rate for Payer: Priority Health HMO/PPO |
$1,730.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,332.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.00
|
| Rate for Payer: UHC Core |
$1,660.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.48
|
|
|
HC OSTO-ZYME
|
Facility
|
IP
|
$43.10
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Aetna Commercial |
$36.63
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: Cash Price |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$37.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.48
|
| Rate for Payer: Healthscope Commercial |
$38.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.63
|
| Rate for Payer: Nomi Health Commercial |
$35.34
|
| Rate for Payer: PHP Commercial |
$36.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.02
|
| Rate for Payer: Priority Health HMO/PPO |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.93
|
| Rate for Payer: UHC Core |
$35.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.33
|
|
|
HC OSTO-ZYME
|
Facility
|
OP
|
$43.10
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Aetna Commercial |
$36.63
|
| Rate for Payer: Aetna Medicare |
$11.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.47
|
| Rate for Payer: BCBS Complete |
$17.24
|
| Rate for Payer: BCBS MAPPO |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.43
|
| Rate for Payer: BCN Commercial |
$33.51
|
| Rate for Payer: BCN Medicare Advantage |
$10.78
|
| Rate for Payer: Cash Price |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$37.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.78
|
| Rate for Payer: Healthscope Commercial |
$38.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.63
|
| Rate for Payer: Nomi Health Commercial |
$35.34
|
| Rate for Payer: PACE Senior Care Partners |
$10.24
|
| Rate for Payer: PACE SWMI |
$10.78
|
| Rate for Payer: PHP Commercial |
$36.63
|
| Rate for Payer: PHP Medicare Advantage |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.02
|
| Rate for Payer: Priority Health HMO/PPO |
$37.50
|
| Rate for Payer: Priority Health Medicare |
$10.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.93
|
| Rate for Payer: UHC Core |
$35.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.78
|
| Rate for Payer: UHC Exchange |
$10.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.78
|
| Rate for Payer: VA VA |
$10.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.33
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$279.25
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$181.51 |
| Max. Negotiated Rate |
$251.32 |
| Rate for Payer: Aetna Commercial |
$237.36
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$223.40
|
| Rate for Payer: Cofinity Commercial |
$240.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.40
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.36
|
| Rate for Payer: Nomi Health Commercial |
$228.99
|
| Rate for Payer: PHP Commercial |
$237.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.51
|
| Rate for Payer: Priority Health HMO/PPO |
$242.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.74
|
| Rate for Payer: UHC Core |
$233.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.44
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$279.25
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$251.32 |
| Rate for Payer: Aetna Commercial |
$237.36
|
| Rate for Payer: Aetna Medicare |
$72.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.27
|
| Rate for Payer: BCBS Complete |
$111.70
|
| Rate for Payer: BCBS MAPPO |
$69.81
|
| Rate for Payer: BCBS Trust/PPO |
$229.57
|
| Rate for Payer: BCN Commercial |
$217.12
|
| Rate for Payer: BCN Medicare Advantage |
$69.81
|
| Rate for Payer: Cash Price |
$223.40
|
| Rate for Payer: Cofinity Commercial |
$240.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.81
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.36
|
| Rate for Payer: Nomi Health Commercial |
$228.99
|
| Rate for Payer: PACE Senior Care Partners |
$66.32
|
| Rate for Payer: PACE SWMI |
$69.81
|
| Rate for Payer: PHP Commercial |
$237.36
|
| Rate for Payer: PHP Medicare Advantage |
$69.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.51
|
| Rate for Payer: Priority Health HMO/PPO |
$242.95
|
| Rate for Payer: Priority Health Medicare |
$70.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.74
|
| Rate for Payer: UHC Core |
$233.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.81
|
| Rate for Payer: UHC Exchange |
$69.81
|
| Rate for Payer: UHC Medicare Advantage |
$69.81
|
| Rate for Payer: VA VA |
$69.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.44
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$228.47
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$205.62 |
| Rate for Payer: Aetna Commercial |
$194.20
|
| Rate for Payer: BCBS Trust/PPO |
$186.50
|
| Rate for Payer: BCN Commercial |
$176.56
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$196.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.78
|
| Rate for Payer: Healthscope Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.20
|
| Rate for Payer: Nomi Health Commercial |
$187.35
|
| Rate for Payer: PHP Commercial |
$194.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health HMO/PPO |
$198.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.05
|
| Rate for Payer: UHC Core |
$190.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.35
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$228.47
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$205.62 |
| Rate for Payer: Aetna Commercial |
$194.20
|
| Rate for Payer: Aetna Medicare |
$59.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.40
|
| Rate for Payer: BCBS Complete |
$91.39
|
| Rate for Payer: BCBS MAPPO |
$57.12
|
| Rate for Payer: BCBS Trust/PPO |
$187.83
|
| Rate for Payer: BCN Commercial |
$177.64
|
| Rate for Payer: BCN Medicare Advantage |
$57.12
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$196.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.20
|
| Rate for Payer: Nomi Health Commercial |
$187.35
|
| Rate for Payer: PACE Senior Care Partners |
$54.26
|
| Rate for Payer: PACE SWMI |
$57.12
|
| Rate for Payer: PHP Commercial |
$194.20
|
| Rate for Payer: PHP Medicare Advantage |
$57.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health HMO/PPO |
$198.77
|
| Rate for Payer: Priority Health Medicare |
$57.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.07
|
| Rate for Payer: Railroad Medicare Medicare |
$57.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.05
|
| Rate for Payer: UHC Core |
$190.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.12
|
| Rate for Payer: UHC Exchange |
$57.12
|
| Rate for Payer: UHC Medicare Advantage |
$57.12
|
| Rate for Payer: VA VA |
$57.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.35
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: BCBS Trust/PPO |
$207.23
|
| Rate for Payer: BCN Commercial |
$196.18
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.33
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$63.47
|
| Rate for Payer: BCBS Trust/PPO |
$208.70
|
| Rate for Payer: BCN Commercial |
$197.38
|
| Rate for Payer: BCN Medicare Advantage |
$63.47
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: PACE Senior Care Partners |
$60.29
|
| Rate for Payer: PACE SWMI |
$63.47
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: PHP Medicare Advantage |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Medicare |
$64.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.09
|
| Rate for Payer: Railroad Medicare Medicare |
$63.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.47
|
| Rate for Payer: UHC Exchange |
$63.47
|
| Rate for Payer: UHC Medicare Advantage |
$63.47
|
| Rate for Payer: VA VA |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: BCBS Trust/PPO |
$98.25
|
| Rate for Payer: BCN Commercial |
$93.01
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.31
|
| Rate for Payer: Nomi Health Commercial |
$98.70
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: Priority Health HMO/PPO |
$104.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna Medicare |
$31.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.61
|
| Rate for Payer: BCBS Complete |
$48.14
|
| Rate for Payer: BCBS MAPPO |
$30.09
|
| Rate for Payer: BCBS Trust/PPO |
$98.95
|
| Rate for Payer: BCN Commercial |
$93.58
|
| Rate for Payer: BCN Medicare Advantage |
$30.09
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.09
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.31
|
| Rate for Payer: Nomi Health Commercial |
$98.70
|
| Rate for Payer: PACE Senior Care Partners |
$28.59
|
| Rate for Payer: PACE SWMI |
$30.09
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: PHP Medicare Advantage |
$30.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: Priority Health HMO/PPO |
$104.71
|
| Rate for Payer: Priority Health Medicare |
$30.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.64
|
| Rate for Payer: Railroad Medicare Medicare |
$30.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.09
|
| Rate for Payer: UHC Exchange |
$30.09
|
| Rate for Payer: UHC Medicare Advantage |
$30.09
|
| Rate for Payer: VA VA |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$83.85
|
| Rate for Payer: BCN Commercial |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PACE Senior Care Partners |
$24.23
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.50
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$31.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$31.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.28
|
| Rate for Payer: PACE SWMI |
$31.88
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Medicare |
$32.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.88
|
| Rate for Payer: UHC Exchange |
$31.88
|
| Rate for Payer: UHC Medicare Advantage |
$31.88
|
| Rate for Payer: VA VA |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
