|
HC OSTIAL PRO SYSTEM
|
Facility
|
OP
|
$2,028.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.51 |
| Max. Negotiated Rate |
$2,028.41 |
| Rate for Payer: Aetna Commercial |
$1,825.57
|
| Rate for Payer: Aetna Medicare |
$750.51
|
| Rate for Payer: ASR ASR |
$1,967.56
|
| Rate for Payer: BCBS Complete |
$811.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.42
|
| Rate for Payer: BCN Commercial |
$1,672.42
|
| Rate for Payer: Cash Price |
$1,622.73
|
| Rate for Payer: Cofinity Commercial |
$1,906.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,622.73
|
| Rate for Payer: Healthscope Commercial |
$1,967.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,028.41
|
| Rate for Payer: Mclaren Commercial |
$1,825.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,622.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,724.15
|
| Rate for Payer: Nomi Health Commercial |
$1,663.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,521.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,777.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,785.00
|
|
|
HC OSTO-ZYME
|
Facility
|
OP
|
$43.96
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$43.96 |
| Rate for Payer: Aetna Commercial |
$39.56
|
| Rate for Payer: Aetna Medicare |
$16.27
|
| Rate for Payer: ASR ASR |
$42.64
|
| Rate for Payer: BCBS Complete |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$36.25
|
| Rate for Payer: BCN Commercial |
$36.25
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cofinity Commercial |
$41.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.17
|
| Rate for Payer: Healthscope Commercial |
$42.64
|
| Rate for Payer: Healthscope Whirlpool |
$43.96
|
| Rate for Payer: Mclaren Commercial |
$39.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: Nomi Health Commercial |
$36.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.52
|
| Rate for Payer: Priority Health Narrow Network |
$30.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.68
|
|
|
HC OSTO-ZYME
|
Facility
|
IP
|
$43.96
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$43.96 |
| Rate for Payer: Aetna Commercial |
$39.56
|
| Rate for Payer: ASR ASR |
$42.64
|
| Rate for Payer: BCBS Trust/PPO |
$36.10
|
| Rate for Payer: BCN Commercial |
$36.10
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cofinity Commercial |
$41.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.17
|
| Rate for Payer: Healthscope Commercial |
$42.64
|
| Rate for Payer: Healthscope Whirlpool |
$43.96
|
| Rate for Payer: Mclaren Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: Nomi Health Commercial |
$36.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.68
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$284.84
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$213.63 |
| Max. Negotiated Rate |
$284.84 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: ASR ASR |
$276.29
|
| Rate for Payer: BCBS Trust/PPO |
$233.91
|
| Rate for Payer: BCN Commercial |
$233.91
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$276.29
|
| Rate for Payer: Healthscope Whirlpool |
$284.84
|
| Rate for Payer: Mclaren Commercial |
$256.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.11
|
| Rate for Payer: Nomi Health Commercial |
$233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.66
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$284.84
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$105.39 |
| Max. Negotiated Rate |
$284.84 |
| Rate for Payer: Aetna Commercial |
$256.36
|
| Rate for Payer: Aetna Medicare |
$105.39
|
| Rate for Payer: ASR ASR |
$276.29
|
| Rate for Payer: BCBS Complete |
$113.94
|
| Rate for Payer: BCBS Trust/PPO |
$234.85
|
| Rate for Payer: BCN Commercial |
$234.85
|
| Rate for Payer: Cash Price |
$227.87
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$276.29
|
| Rate for Payer: Healthscope Whirlpool |
$284.84
|
| Rate for Payer: Mclaren Commercial |
$256.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.11
|
| Rate for Payer: Nomi Health Commercial |
$233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.58
|
| Rate for Payer: Priority Health Narrow Network |
$199.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.66
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$233.04
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$86.22 |
| Max. Negotiated Rate |
$233.04 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$86.22
|
| Rate for Payer: ASR ASR |
$226.05
|
| Rate for Payer: BCBS Complete |
$93.22
|
| Rate for Payer: BCBS Trust/PPO |
$192.14
|
| Rate for Payer: BCN Commercial |
$192.14
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cofinity Commercial |
$219.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.43
|
| Rate for Payer: Healthscope Commercial |
$226.05
|
| Rate for Payer: Healthscope Whirlpool |
$233.04
|
| Rate for Payer: Mclaren Commercial |
$209.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.08
|
| Rate for Payer: Nomi Health Commercial |
$191.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$204.19
|
| Rate for Payer: Priority Health Narrow Network |
$163.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.08
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$233.04
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$174.78 |
| Max. Negotiated Rate |
$233.04 |
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: ASR ASR |
$226.05
|
| Rate for Payer: BCBS Trust/PPO |
$191.37
|
| Rate for Payer: BCN Commercial |
$191.37
|
| Rate for Payer: Cash Price |
$186.43
|
| Rate for Payer: Cofinity Commercial |
$219.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.43
|
| Rate for Payer: Healthscope Commercial |
$226.05
|
| Rate for Payer: Healthscope Whirlpool |
$233.04
|
| Rate for Payer: Mclaren Commercial |
$209.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.08
|
| Rate for Payer: Nomi Health Commercial |
$191.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.08
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$258.94
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$258.94 |
| Rate for Payer: Aetna Commercial |
$233.05
|
| Rate for Payer: ASR ASR |
$251.17
|
| Rate for Payer: BCBS Trust/PPO |
$212.64
|
| Rate for Payer: BCN Commercial |
$212.64
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$243.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.15
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Healthscope Whirlpool |
$258.94
|
| Rate for Payer: Mclaren Commercial |
$233.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.10
|
| Rate for Payer: Nomi Health Commercial |
$212.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.87
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$258.94
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$258.94 |
| Rate for Payer: Aetna Commercial |
$233.05
|
| Rate for Payer: Aetna Medicare |
$95.81
|
| Rate for Payer: ASR ASR |
$251.17
|
| Rate for Payer: BCBS Complete |
$103.58
|
| Rate for Payer: BCBS Trust/PPO |
$213.50
|
| Rate for Payer: BCN Commercial |
$213.50
|
| Rate for Payer: Cash Price |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$243.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.15
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Healthscope Whirlpool |
$258.94
|
| Rate for Payer: Mclaren Commercial |
$233.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.10
|
| Rate for Payer: Nomi Health Commercial |
$212.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.88
|
| Rate for Payer: Priority Health Narrow Network |
$181.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.87
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$124.62
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: Aetna Medicare |
$46.11
|
| Rate for Payer: ASR ASR |
$120.88
|
| Rate for Payer: BCBS Complete |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$102.75
|
| Rate for Payer: BCN Commercial |
$102.75
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$120.88
|
| Rate for Payer: Healthscope Whirlpool |
$124.62
|
| Rate for Payer: Mclaren Commercial |
$112.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.19
|
| Rate for Payer: Priority Health Narrow Network |
$87.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.67
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$124.62
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: ASR ASR |
$120.88
|
| Rate for Payer: BCBS Trust/PPO |
$102.34
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$120.88
|
| Rate for Payer: Healthscope Whirlpool |
$124.62
|
| Rate for Payer: Mclaren Commercial |
$112.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.67
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$85.78
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.16
|
| Rate for Payer: Priority Health Narrow Network |
$72.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC OT Z GAUNTLET EA $100
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.44
|
| Rate for Payer: BCN Commercial |
$85.44
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
OP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.12 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$48.12
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$107.23
|
| Rate for Payer: BCN Commercial |
$107.23
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.95
|
| Rate for Payer: Priority Health Narrow Network |
$91.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC OT Z GAUNTLET EA $125
|
Facility
|
IP
|
$130.05
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: ASR ASR |
$126.15
|
| Rate for Payer: BCBS Trust/PPO |
$106.80
|
| Rate for Payer: BCN Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Commercial |
$122.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$126.15
|
| Rate for Payer: Healthscope Whirlpool |
$130.05
|
| Rate for Payer: Mclaren Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC OT Z GAUNTLET EA $150
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: Aetna Medicare |
$67.37
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Complete |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.12
|
| Rate for Payer: BCN Commercial |
$150.12
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.53
|
| Rate for Payer: Priority Health Narrow Network |
$127.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
|
|
HC OT Z GAUNTLET EA $175
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.55 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: ASR ASR |
$176.61
|
| Rate for Payer: BCBS Trust/PPO |
$149.52
|
| Rate for Payer: BCN Commercial |
$149.52
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$171.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$176.61
|
| Rate for Payer: Healthscope Whirlpool |
$182.07
|
| Rate for Payer: Mclaren Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.22
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC OT Z GAUNTLET EA $20
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$171.56
|
| Rate for Payer: BCN Commercial |
$171.56
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.84
|
| Rate for Payer: Healthscope Whirlpool |
$208.08
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.32
|
| Rate for Payer: Priority Health Narrow Network |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC OT Z GAUNTLET EA $200
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.06 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: BCBS Trust/PPO |
$170.88
|
| Rate for Payer: BCN Commercial |
$170.88
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$201.84
|
| Rate for Payer: Healthscope Whirlpool |
$208.08
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
