|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
IP
|
$58.25
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$58.25 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: ASR ASR |
$56.50
|
| Rate for Payer: BCBS Trust/PPO |
$45.16
|
| Rate for Payer: BCN Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Healthscope Commercial |
$58.25
|
| Rate for Payer: Healthscope Whirlpool |
$56.50
|
| Rate for Payer: Mclaren Commercial |
$52.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.26
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
OP
|
$59.54
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.82
|
| Rate for Payer: ASR ASR |
$57.75
|
| Rate for Payer: BCBS Complete |
$13.25
|
| Rate for Payer: BCBS MAPPO |
$23.06
|
| Rate for Payer: BCBS Trust/PPO |
$46.16
|
| Rate for Payer: BCN Commercial |
$46.16
|
| Rate for Payer: BCN Medicare Advantage |
$23.06
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$57.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.06
|
| Rate for Payer: Mclaren Commercial |
$53.59
|
| Rate for Payer: Mclaren Medicaid |
$12.61
|
| Rate for Payer: Mclaren Medicare |
$23.06
|
| Rate for Payer: Meridian Medicaid |
$13.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.61
|
| Rate for Payer: PACE Medicare |
$21.91
|
| Rate for Payer: PACE SWMI |
$23.06
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: PHP Medicaid |
$12.61
|
| Rate for Payer: PHP Medicare Advantage |
$23.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.18
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Narrow Network |
$42.27
|
| Rate for Payer: Railroad Medicare Medicare |
$23.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.40
|
| Rate for Payer: UHC Medicare Advantage |
$23.75
|
| Rate for Payer: VA VA |
$23.06
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
IP
|
$59.54
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Aetna Commercial |
$53.59
|
| Rate for Payer: ASR ASR |
$57.75
|
| Rate for Payer: BCBS Trust/PPO |
$46.16
|
| Rate for Payer: BCN Commercial |
$46.16
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$57.75
|
| Rate for Payer: Mclaren Commercial |
$53.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.40
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
OP
|
$64.32
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$57.89
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.82
|
| Rate for Payer: ASR ASR |
$62.39
|
| Rate for Payer: BCBS Complete |
$13.25
|
| Rate for Payer: BCBS MAPPO |
$23.06
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$49.87
|
| Rate for Payer: BCN Medicare Advantage |
$23.06
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$64.32
|
| Rate for Payer: Healthscope Whirlpool |
$62.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.06
|
| Rate for Payer: Mclaren Commercial |
$57.89
|
| Rate for Payer: Mclaren Medicaid |
$12.61
|
| Rate for Payer: Mclaren Medicare |
$23.06
|
| Rate for Payer: Meridian Medicaid |
$13.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.67
|
| Rate for Payer: PACE Medicare |
$21.91
|
| Rate for Payer: PACE SWMI |
$23.06
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: PHP Medicaid |
$12.61
|
| Rate for Payer: PHP Medicare Advantage |
$23.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.53
|
| Rate for Payer: Priority Health Medicare |
$23.06
|
| Rate for Payer: Priority Health Narrow Network |
$45.67
|
| Rate for Payer: Railroad Medicare Medicare |
$23.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.75
|
| Rate for Payer: VA VA |
$23.06
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
IP
|
$64.32
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$57.89
|
| Rate for Payer: ASR ASR |
$62.39
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$49.87
|
| Rate for Payer: Cash Price |
$51.46
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.46
|
| Rate for Payer: Healthscope Commercial |
$64.32
|
| Rate for Payer: Healthscope Whirlpool |
$62.39
|
| Rate for Payer: Mclaren Commercial |
$57.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.60
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
IP
|
$1,949.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,364.76 |
| Max. Negotiated Rate |
$1,949.65 |
| Rate for Payer: Aetna Commercial |
$1,754.68
|
| Rate for Payer: ASR ASR |
$1,891.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.56
|
| Rate for Payer: BCN Commercial |
$1,511.56
|
| Rate for Payer: Cash Price |
$1,559.72
|
| Rate for Payer: Cofinity Commercial |
$1,832.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.72
|
| Rate for Payer: Healthscope Commercial |
$1,949.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,891.16
|
| Rate for Payer: Mclaren Commercial |
$1,754.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,657.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,364.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.69
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
OP
|
$1,949.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$779.86 |
| Max. Negotiated Rate |
$1,949.65 |
| Rate for Payer: Aetna Commercial |
$1,754.68
|
| Rate for Payer: ASR ASR |
$1,891.16
|
| Rate for Payer: BCBS Complete |
$779.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.56
|
| Rate for Payer: BCN Commercial |
$1,511.56
|
| Rate for Payer: Cash Price |
$1,559.72
|
| Rate for Payer: Cofinity Commercial |
$1,832.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.72
|
| Rate for Payer: Healthscope Commercial |
$1,949.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,891.16
|
| Rate for Payer: Mclaren Commercial |
$1,754.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,657.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,364.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,774.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,384.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.69
|
|
|
HC OSTO-ZYME
|
Facility
|
OP
|
$42.25
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Aetna Commercial |
$38.02
|
| Rate for Payer: ASR ASR |
$40.98
|
| Rate for Payer: BCBS Complete |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$32.76
|
| Rate for Payer: BCN Commercial |
$32.76
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$39.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.80
|
| Rate for Payer: Healthscope Commercial |
$42.25
|
| Rate for Payer: Healthscope Whirlpool |
$40.98
|
| Rate for Payer: Mclaren Commercial |
$38.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.45
|
| Rate for Payer: Priority Health Narrow Network |
$30.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.18
|
|
|
HC OSTO-ZYME
|
Facility
|
IP
|
$42.25
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Aetna Commercial |
$38.02
|
| Rate for Payer: ASR ASR |
$40.98
|
| Rate for Payer: BCBS Trust/PPO |
$32.76
|
| Rate for Payer: BCN Commercial |
$32.76
|
| Rate for Payer: Cash Price |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$39.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.80
|
| Rate for Payer: Healthscope Commercial |
$42.25
|
| Rate for Payer: Healthscope Whirlpool |
$40.98
|
| Rate for Payer: Mclaren Commercial |
$38.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.18
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$273.77
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$191.64 |
| Max. Negotiated Rate |
$273.77 |
| Rate for Payer: Aetna Commercial |
$246.39
|
| Rate for Payer: ASR ASR |
$265.56
|
| Rate for Payer: BCBS Trust/PPO |
$212.25
|
| Rate for Payer: BCN Commercial |
$212.25
|
| Rate for Payer: Cash Price |
$219.02
|
| Rate for Payer: Cofinity Commercial |
$257.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.02
|
| Rate for Payer: Healthscope Commercial |
$273.77
|
| Rate for Payer: Healthscope Whirlpool |
$265.56
|
| Rate for Payer: Mclaren Commercial |
$246.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.92
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$273.77
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$109.51 |
| Max. Negotiated Rate |
$273.77 |
| Rate for Payer: Aetna Commercial |
$246.39
|
| Rate for Payer: ASR ASR |
$265.56
|
| Rate for Payer: BCBS Complete |
$109.51
|
| Rate for Payer: BCBS Trust/PPO |
$212.25
|
| Rate for Payer: BCN Commercial |
$212.25
|
| Rate for Payer: Cash Price |
$219.02
|
| Rate for Payer: Cofinity Commercial |
$257.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.02
|
| Rate for Payer: Healthscope Commercial |
$273.77
|
| Rate for Payer: Healthscope Whirlpool |
$265.56
|
| Rate for Payer: Mclaren Commercial |
$246.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.13
|
| Rate for Payer: Priority Health Narrow Network |
$194.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.92
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$223.99
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$223.99 |
| Rate for Payer: Aetna Commercial |
$201.59
|
| Rate for Payer: ASR ASR |
$217.27
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS Trust/PPO |
$173.66
|
| Rate for Payer: BCN Commercial |
$173.66
|
| Rate for Payer: Cash Price |
$179.19
|
| Rate for Payer: Cofinity Commercial |
$210.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.19
|
| Rate for Payer: Healthscope Commercial |
$223.99
|
| Rate for Payer: Healthscope Whirlpool |
$217.27
|
| Rate for Payer: Mclaren Commercial |
$201.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.83
|
| Rate for Payer: Priority Health Narrow Network |
$159.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.11
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$223.99
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$156.79 |
| Max. Negotiated Rate |
$223.99 |
| Rate for Payer: Aetna Commercial |
$201.59
|
| Rate for Payer: ASR ASR |
$217.27
|
| Rate for Payer: BCBS Trust/PPO |
$173.66
|
| Rate for Payer: BCN Commercial |
$173.66
|
| Rate for Payer: Cash Price |
$179.19
|
| Rate for Payer: Cofinity Commercial |
$210.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.19
|
| Rate for Payer: Healthscope Commercial |
$223.99
|
| Rate for Payer: Healthscope Whirlpool |
$217.27
|
| Rate for Payer: Mclaren Commercial |
$201.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.11
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$248.88
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$99.55 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: BCBS Complete |
$99.55
|
| Rate for Payer: BCBS Trust/PPO |
$192.96
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.48
|
| Rate for Payer: Priority Health Narrow Network |
$176.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$248.88
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$174.22 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: BCBS Trust/PPO |
$192.96
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.49
|
| Rate for Payer: BCN Commercial |
$91.49
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$118.00
|
| Rate for Payer: Healthscope Whirlpool |
$114.46
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.38
|
| Rate for Payer: Priority Health Narrow Network |
$83.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Trust/PPO |
$91.49
|
| Rate for Payer: BCN Commercial |
$91.49
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$118.00
|
| Rate for Payer: Healthscope Whirlpool |
$114.46
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: ASR ASR |
$97.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$77.53
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$94.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$100.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.00
|
| Rate for Payer: Priority Health Narrow Network |
$71.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.00
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: ASR ASR |
$97.00
|
| Rate for Payer: BCBS Trust/PPO |
$77.53
|
| Rate for Payer: BCN Commercial |
$77.53
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$94.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$100.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$90.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.00
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.75
|
| Rate for Payer: Priority Health Narrow Network |
$88.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.50
|
| Rate for Payer: Priority Health Narrow Network |
$106.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
