|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$107.13
|
| Rate for Payer: BCN Commercial |
$107.13
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$284.84
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$125.33 |
| Max. Negotiated Rate |
$256.36 |
| Rate for Payer: Aetna American Axle |
$185.15
|
| Rate for Payer: Aetna Commercial |
$242.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.15
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cofinity Advantage |
$199.39
|
| Rate for Payer: Cofinity Commercial |
$244.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$256.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.63
|
| Rate for Payer: PHP Commercial |
$242.11
|
| Rate for Payer: Priority Health SBD |
$179.45
|
| Rate for Payer: UMR Bronson Commercial |
$125.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.63
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$284.84
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$256.36 |
| Rate for Payer: Aetna American Axle |
$185.15
|
| Rate for Payer: Aetna Commercial |
$242.11
|
| Rate for Payer: Aetna Medicare |
$142.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.15
|
| Rate for Payer: BCBS Complete |
$113.94
|
| Rate for Payer: BCBS Trust/PPO |
$84.08
|
| Rate for Payer: BCN Commercial |
$84.08
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cofinity Advantage |
$199.39
|
| Rate for Payer: Cofinity Commercial |
$244.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$256.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.11
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.63
|
| Rate for Payer: PHP Commercial |
$242.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.00
|
| Rate for Payer: Priority Health SBD |
$179.45
|
| Rate for Payer: Priority Health Tiered Network |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.15
|
| Rate for Payer: UHC Core |
$148.40
|
| Rate for Payer: UHC Exchange |
$111.94
|
| Rate for Payer: UMR Bronson Commercial |
$105.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.63
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$233.04
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$209.74 |
| Rate for Payer: Aetna American Axle |
$151.48
|
| Rate for Payer: Aetna Commercial |
$198.08
|
| Rate for Payer: Aetna Medicare |
$116.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.48
|
| Rate for Payer: BCBS Complete |
$93.22
|
| Rate for Payer: BCBS Trust/PPO |
$84.40
|
| Rate for Payer: BCN Commercial |
$84.40
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cofinity Advantage |
$163.13
|
| Rate for Payer: Cofinity Commercial |
$200.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.43
|
| Rate for Payer: Healthscope Commercial |
$209.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.08
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.78
|
| Rate for Payer: PHP Commercial |
$198.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.00
|
| Rate for Payer: Priority Health SBD |
$146.82
|
| Rate for Payer: Priority Health Tiered Network |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.48
|
| Rate for Payer: UHC Core |
$121.41
|
| Rate for Payer: UHC Exchange |
$91.58
|
| Rate for Payer: UMR Bronson Commercial |
$86.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.78
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$233.04
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$102.54 |
| Max. Negotiated Rate |
$209.74 |
| Rate for Payer: Aetna American Axle |
$151.48
|
| Rate for Payer: Aetna Commercial |
$198.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.48
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cofinity Advantage |
$163.13
|
| Rate for Payer: Cofinity Commercial |
$200.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.43
|
| Rate for Payer: Healthscope Commercial |
$209.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.78
|
| Rate for Payer: PHP Commercial |
$198.08
|
| Rate for Payer: Priority Health SBD |
$146.82
|
| Rate for Payer: UMR Bronson Commercial |
$102.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.78
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$258.94
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$113.93 |
| Max. Negotiated Rate |
$233.05 |
| Rate for Payer: Aetna American Axle |
$168.31
|
| Rate for Payer: Aetna Commercial |
$220.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.31
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cofinity Advantage |
$181.26
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.21
|
| Rate for Payer: PHP Commercial |
$220.10
|
| Rate for Payer: Priority Health SBD |
$163.13
|
| Rate for Payer: UMR Bronson Commercial |
$113.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.21
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$258.94
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$233.05 |
| Rate for Payer: Aetna American Axle |
$168.31
|
| Rate for Payer: Aetna Commercial |
$220.10
|
| Rate for Payer: Aetna Medicare |
$129.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.31
|
| Rate for Payer: BCBS Complete |
$103.58
|
| Rate for Payer: BCBS Trust/PPO |
$84.08
|
| Rate for Payer: BCN Commercial |
$84.08
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cofinity Advantage |
$181.26
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.10
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| 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/Narrow Network |
$76.00
|
| Rate for Payer: Priority Health SBD |
$163.13
|
| Rate for Payer: Priority Health Tiered Network |
$60.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.31
|
| Rate for Payer: UHC Core |
$134.91
|
| Rate for Payer: UHC Exchange |
$101.76
|
| Rate for Payer: UMR Bronson Commercial |
$95.81
|
| 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 |
$30.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$81.00
|
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Medicare |
$62.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.00
|
| Rate for Payer: BCBS Complete |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$58.22
|
| Rate for Payer: BCN Commercial |
$58.22
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Advantage |
$87.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$87.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| 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/Narrow Network |
$38.00
|
| Rate for Payer: Priority Health SBD |
$78.51
|
| Rate for Payer: Priority Health Tiered Network |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.00
|
| Rate for Payer: UHC Core |
$64.93
|
| Rate for Payer: UHC Exchange |
$48.98
|
| Rate for Payer: UMR Bronson Commercial |
$46.11
|
| 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 |
$54.83 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna American Axle |
$81.00
|
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.00
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Advantage |
$87.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$87.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.47
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: Priority Health SBD |
$78.51
|
| Rate for Payer: UMR Bronson Commercial |
$54.83
|
| 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 |
$38.49 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.63
|
| Rate for Payer: UHC Core |
$54.20
|
| Rate for Payer: UHC Exchange |
$40.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| 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 |
$45.78 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$45.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
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 |
$48.12 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
| Rate for Payer: UMR Bronson Commercial |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.54
|
|
|
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 |
$57.22 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna American Axle |
$84.53
|
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$91.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UMR Bronson Commercial |
$57.22
|
| 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 |
$68.67 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UMR Bronson Commercial |
$68.67
|
| 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 |
$57.74 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.44
|
| Rate for Payer: UHC Core |
$81.31
|
| Rate for Payer: UHC Exchange |
$61.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
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 |
$80.11 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna American Axle |
$118.35
|
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$127.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health SBD |
$114.70
|
| Rate for Payer: UMR Bronson Commercial |
$80.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
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 |
$67.37 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$118.35
|
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna Medicare |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: BCBS Complete |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$127.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health SBD |
$114.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.35
|
| Rate for Payer: UHC Core |
$94.86
|
| Rate for Payer: UHC Exchange |
$71.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
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 |
$7.70 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$10.84
|
| Rate for Payer: UHC Exchange |
$8.18
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
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 |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
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 |
$76.99 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$135.25
|
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: Aetna Medicare |
$104.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.25
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Advantage |
$145.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$145.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: Priority Health SBD |
$131.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.25
|
| Rate for Payer: UHC Core |
$108.41
|
| Rate for Payer: UHC Exchange |
$81.78
|
| Rate for Payer: UMR Bronson Commercial |
$76.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
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 |
$91.56 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna American Axle |
$135.25
|
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.25
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Advantage |
$145.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$145.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: Priority Health SBD |
$131.09
|
| Rate for Payer: UMR Bronson Commercial |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
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 |
$103.00 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna American Axle |
$152.16
|
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Advantage |
$163.86
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health SBD |
$147.48
|
| Rate for Payer: UMR Bronson Commercial |
$103.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
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 |
$86.61 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$152.16
|
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna Medicare |
$117.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: BCBS Complete |
$93.64
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Advantage |
$163.86
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.57
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health SBD |
$147.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.16
|
| Rate for Payer: UHC Core |
$121.96
|
| Rate for Payer: UHC Exchange |
$92.00
|
| Rate for Payer: UMR Bronson Commercial |
$86.61
|
| 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 |
$96.24 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$169.06
|
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: BCBS Complete |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$182.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.06
|
| Rate for Payer: UHC Core |
$135.51
|
| Rate for Payer: UHC Exchange |
$102.22
|
| Rate for Payer: UMR Bronson Commercial |
$96.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
