|
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 |
$114.44 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna American Axle |
$169.06
|
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| 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: 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: UMR Bronson Commercial |
$114.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
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 |
$125.89 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna American Axle |
$185.97
|
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$200.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UMR Bronson Commercial |
$125.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
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 |
$105.86 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$185.97
|
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$200.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.97
|
| Rate for Payer: UHC Core |
$149.06
|
| Rate for Payer: UHC Exchange |
$112.44
|
| Rate for Payer: UMR Bronson Commercial |
$105.86
|
| 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 |
$115.48 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$202.88
|
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$156.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.88
|
| Rate for Payer: BCBS Complete |
$124.85
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Advantage |
$218.48
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$218.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health SBD |
$196.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.88
|
| Rate for Payer: UHC Core |
$162.61
|
| Rate for Payer: UHC Exchange |
$122.66
|
| Rate for Payer: UMR Bronson Commercial |
$115.48
|
| 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 |
$137.33 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna American Axle |
$202.88
|
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.88
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Advantage |
$218.48
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$218.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health SBD |
$196.64
|
| Rate for Payer: UMR Bronson Commercial |
$137.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
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 |
$148.78 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna American Axle |
$219.78
|
| Rate for Payer: Aetna Commercial |
$287.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.78
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Advantage |
$236.69
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$236.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: PHP Commercial |
$287.41
|
| Rate for Payer: Priority Health SBD |
$213.02
|
| Rate for Payer: UMR Bronson Commercial |
$148.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.60
|
|
|
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 |
$125.11 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$219.78
|
| Rate for Payer: Aetna Commercial |
$287.41
|
| Rate for Payer: Aetna Medicare |
$169.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.78
|
| Rate for Payer: BCBS Complete |
$135.25
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cofinity Advantage |
$236.69
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$236.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.60
|
| Rate for Payer: PHP Commercial |
$287.41
|
| Rate for Payer: Priority Health SBD |
$213.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.78
|
| Rate for Payer: UHC Core |
$176.17
|
| Rate for Payer: UHC Exchange |
$132.89
|
| Rate for Payer: UMR Bronson Commercial |
$125.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.60
|
|
|
HC OT Z GAUNTLET EA $350
|
Facility
|
OP
|
$364.14
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$236.69
|
| Rate for Payer: Aetna Commercial |
$309.52
|
| Rate for Payer: Aetna Medicare |
$182.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.69
|
| Rate for Payer: BCBS Complete |
$145.66
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Advantage |
$254.90
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.31
|
| Rate for Payer: Healthscope Commercial |
$327.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.11
|
| Rate for Payer: PHP Commercial |
$309.52
|
| Rate for Payer: Priority Health SBD |
$229.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.69
|
| Rate for Payer: UHC Core |
$189.72
|
| Rate for Payer: UHC Exchange |
$143.11
|
| Rate for Payer: UMR Bronson Commercial |
$134.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.11
|
|
|
HC OT Z GAUNTLET EA $350
|
Facility
|
IP
|
$364.14
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.22 |
| Max. Negotiated Rate |
$327.73 |
| Rate for Payer: Aetna American Axle |
$236.69
|
| Rate for Payer: Aetna Commercial |
$309.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.69
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Advantage |
$254.90
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.31
|
| Rate for Payer: Healthscope Commercial |
$327.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.11
|
| Rate for Payer: PHP Commercial |
$309.52
|
| Rate for Payer: Priority Health SBD |
$229.41
|
| Rate for Payer: UMR Bronson Commercial |
$160.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.11
|
|
|
HC OT Z GAUNTLET EA $375
|
Facility
|
OP
|
$390.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna American Axle |
$253.60
|
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna Medicare |
$195.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: BCBS Complete |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.60
|
| Rate for Payer: UHC Core |
$203.27
|
| Rate for Payer: UHC Exchange |
$153.33
|
| Rate for Payer: UMR Bronson Commercial |
$144.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.61
|
|
|
HC OT Z GAUNTLET EA $375
|
Facility
|
IP
|
$390.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.67 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna American Axle |
$253.60
|
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
| Rate for Payer: UMR Bronson Commercial |
$171.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.61
|
|
|
HC OT Z GAUNTLET EA $400
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.98 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna American Axle |
$270.50
|
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna Medicare |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Advantage |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health SBD |
$262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.50
|
| Rate for Payer: UHC Core |
$216.82
|
| Rate for Payer: UHC Exchange |
$163.55
|
| Rate for Payer: UMR Bronson Commercial |
$153.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC OT Z GAUNTLET EA $400
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.11 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna American Axle |
$270.50
|
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Advantage |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.12
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health SBD |
$262.18
|
| Rate for Payer: UMR Bronson Commercial |
$183.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.12
|
|
|
HC OT Z GAUNTLET EA $425
|
Facility
|
IP
|
$442.17
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$194.55 |
| Max. Negotiated Rate |
$397.95 |
| Rate for Payer: Aetna American Axle |
$287.41
|
| Rate for Payer: Aetna Commercial |
$375.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.41
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Advantage |
$309.52
|
| Rate for Payer: Cofinity Commercial |
$380.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$397.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: PHP Commercial |
$375.84
|
| Rate for Payer: Priority Health SBD |
$278.57
|
| Rate for Payer: UMR Bronson Commercial |
$194.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.63
|
|
|
HC OT Z GAUNTLET EA $425
|
Facility
|
OP
|
$442.17
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$397.95 |
| Rate for Payer: Aetna American Axle |
$287.41
|
| Rate for Payer: Aetna Commercial |
$375.84
|
| Rate for Payer: Aetna Medicare |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.41
|
| Rate for Payer: BCBS Complete |
$176.87
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cash Price |
$353.74
|
| Rate for Payer: Cofinity Advantage |
$309.52
|
| Rate for Payer: Cofinity Commercial |
$380.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.74
|
| Rate for Payer: Healthscope Commercial |
$397.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.63
|
| Rate for Payer: PHP Commercial |
$375.84
|
| Rate for Payer: Priority Health SBD |
$278.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.41
|
| Rate for Payer: UHC Core |
$230.37
|
| Rate for Payer: UHC Exchange |
$173.77
|
| Rate for Payer: UMR Bronson Commercial |
$163.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.63
|
|
|
HC OT Z GAUNTLET EA $450
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UMR Bronson Commercial |
$206.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC OT Z GAUNTLET EA $450
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.23 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$234.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: BCBS Complete |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.32
|
| Rate for Payer: UHC Core |
$243.92
|
| Rate for Payer: UHC Exchange |
$183.99
|
| Rate for Payer: UMR Bronson Commercial |
$173.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC OT Z GAUNTLET EA $60
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC OT Z GAUNTLET EA $60
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC OT Z GAUNTLET EA $70
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: UHC Exchange |
$28.62
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC OT Z GAUNTLET EA $70
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC OT Z GAUNTLET EA $80
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.10
|
| Rate for Payer: UHC Core |
$43.36
|
| Rate for Payer: UHC Exchange |
$32.71
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC OT Z GAUNTLET EA $80
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300092
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UMR Bronson Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC OT Z GAUNTLET EA $90
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC OT Z GAUNTLET EA $90
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$347.38 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| Rate for Payer: BCN Commercial |
$347.38
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$48.79
|
| Rate for Payer: UHC Exchange |
$36.80
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
