|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$165.01
|
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$126.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.01
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$71.61
|
| Rate for Payer: BCN Commercial |
$71.61
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.70
|
| 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 |
$135.00
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.00
|
| Rate for Payer: Priority Health Narrow Network |
$60.80
|
| Rate for Payer: Priority Health SBD |
$159.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.06
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$95.51
|
| Rate for Payer: UMR Bronson Commercial |
$93.93
|
| 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 |
$52.96 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna American Axle |
$78.23
|
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.31
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: Priority Health SBD |
$75.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.96
|
| 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 |
$30.40 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$78.23
|
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna Medicare |
$60.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: BCBS Complete |
$48.14
|
| Rate for Payer: BCBS Trust/PPO |
$49.59
|
| Rate for Payer: BCN Commercial |
$49.59
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.25
|
| 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 |
$135.00
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.00
|
| Rate for Payer: Priority Health Narrow Network |
$30.40
|
| Rate for Payer: Priority Health SBD |
$75.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.27
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$65.70
|
| Rate for Payer: UMR Bronson Commercial |
$44.53
|
| 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 |
$44.88 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.88
|
| 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 |
$37.74 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: UMR Bronson Commercial |
$37.74
|
| 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 |
$56.10 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna American Axle |
$82.88
|
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.32
|
| Rate for Payer: UMR Bronson Commercial |
$56.10
|
| 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 |
$47.18 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$82.88
|
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.32
|
| Rate for Payer: UMR Bronson Commercial |
$47.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
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 |
$56.61 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
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 |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$132.60
|
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: UMR Bronson Commercial |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna American Axle |
$132.60
|
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: UMR Bronson Commercial |
$89.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.92 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$149.18
|
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health SBD |
$144.58
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC OT Z GAUNTLET EA $225
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna American Axle |
$149.18
|
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health SBD |
$144.58
|
| Rate for Payer: UMR Bronson Commercial |
$100.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$94.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC OT Z GAUNTLET EA $250
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$112.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$123.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z GAUNTLET EA $275
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$103.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna American Axle |
$198.90
|
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: UMR Bronson Commercial |
$134.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z GAUNTLET EA $300
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$198.90
|
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: UMR Bronson Commercial |
$113.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
IP
|
$331.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna American Axle |
$215.48
|
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health SBD |
$208.84
|
| Rate for Payer: UMR Bronson Commercial |
$145.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
|
HC OT Z GAUNTLET EA $325
|
Facility
|
OP
|
$331.50
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.66 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna American Axle |
$215.48
|
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna Medicare |
$165.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: BCBS Complete |
$132.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.53
|
| Rate for Payer: BCN Commercial |
$347.53
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health SBD |
$208.84
|
| Rate for Payer: UMR Bronson Commercial |
$122.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.62
|
|
