|
HC OSTEOPATHIC MANIPULATION 1-2 BODY REGIONS
|
Facility
|
IP
|
$31.52
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
53000001
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: ASR ASR |
$30.57
|
| Rate for Payer: ASR Commercial |
$30.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$29.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.22
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.57
|
| Rate for Payer: Mclaren Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.79
|
| Rate for Payer: Nomi Health Commercial |
$25.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.74
|
|
|
HC OSTEOPATHIC MANIPULATION 1-2 BODY REGIONS
|
Facility
|
OP
|
$31.52
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
53000001
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$38.24 |
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna Medicare |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$30.57
|
| Rate for Payer: ASR Commercial |
$30.57
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.81
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$24.67
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$29.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.67
|
| Rate for Payer: Mclaren Commercial |
$28.37
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$24.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.79
|
| Rate for Payer: Nomi Health Commercial |
$25.85
|
| Rate for Payer: PACE Medicare |
$23.44
|
| Rate for Payer: PACE SWMI |
$24.67
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicaid |
$13.22
|
| Rate for Payer: PHP Medicare Advantage |
$24.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.62
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow Network |
$22.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.67
|
| Rate for Payer: UHC Exchange |
$38.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.67
|
| Rate for Payer: UHCCP DNSP |
$24.67
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$24.67
|
|
|
HC OSTEOPATHIC MANIPULATION 3-4 BODY REGIONS
|
Facility
|
OP
|
$31.52
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
53000002
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$38.24 |
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna Medicare |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$30.57
|
| Rate for Payer: ASR Commercial |
$30.57
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.81
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$24.67
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$29.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.67
|
| Rate for Payer: Mclaren Commercial |
$28.37
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$24.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.79
|
| Rate for Payer: Nomi Health Commercial |
$25.85
|
| Rate for Payer: PACE Medicare |
$23.44
|
| Rate for Payer: PACE SWMI |
$24.67
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicaid |
$13.22
|
| Rate for Payer: PHP Medicare Advantage |
$24.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.62
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow Network |
$22.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.67
|
| Rate for Payer: UHC Exchange |
$38.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.67
|
| Rate for Payer: UHCCP DNSP |
$24.67
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$24.67
|
|
|
HC OSTEOPATHIC MANIPULATION 3-4 BODY REGIONS
|
Facility
|
IP
|
$31.52
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
53000002
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: ASR ASR |
$30.57
|
| Rate for Payer: ASR Commercial |
$30.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.22
|
| Rate for Payer: Cofinity Commercial |
$29.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.22
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Healthscope Whirlpool |
$30.57
|
| Rate for Payer: Mclaren Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.79
|
| Rate for Payer: Nomi Health Commercial |
$25.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.74
|
|
|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
IP
|
$59.42
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$59.42 |
| Rate for Payer: Aetna Commercial |
$53.48
|
| Rate for Payer: ASR ASR |
$57.64
|
| Rate for Payer: ASR Commercial |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$48.42
|
| Rate for Payer: BCN Commercial |
$46.07
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$55.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$59.42
|
| Rate for Payer: Healthscope Whirlpool |
$57.64
|
| Rate for Payer: Mclaren Commercial |
$53.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.51
|
| Rate for Payer: Nomi Health Commercial |
$48.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.29
|
|
|
HC OSTEOPATHIC MANIPULATION 5-6 BODY REGIONS
|
Facility
|
OP
|
$59.42
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
53000003
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$59.42 |
| Rate for Payer: Aetna Commercial |
$53.48
|
| Rate for Payer: Aetna Medicare |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$57.64
|
| Rate for Payer: ASR Commercial |
$57.64
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$48.66
|
| Rate for Payer: BCN Commercial |
$46.07
|
| Rate for Payer: BCN Medicare Advantage |
$24.67
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$55.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$59.42
|
| Rate for Payer: Healthscope Whirlpool |
$57.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.67
|
| Rate for Payer: Mclaren Commercial |
$53.48
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$24.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.51
|
| Rate for Payer: Nomi Health Commercial |
$48.72
|
| Rate for Payer: PACE Medicare |
$23.44
|
| Rate for Payer: PACE SWMI |
$24.67
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicaid |
$13.22
|
| Rate for Payer: PHP Medicare Advantage |
$24.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.06
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow Network |
$41.65
|
| Rate for Payer: Railroad Medicare Medicare |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.67
|
| Rate for Payer: UHC Exchange |
$38.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.67
|
| Rate for Payer: UHCCP DNSP |
$24.67
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$24.67
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
IP
|
$60.73
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$60.73 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: ASR ASR |
$58.91
|
| Rate for Payer: ASR Commercial |
$58.91
|
| Rate for Payer: BCBS Trust/PPO |
$49.49
|
| Rate for Payer: BCN Commercial |
$47.08
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cofinity Commercial |
$57.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.58
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$58.91
|
| Rate for Payer: Mclaren Commercial |
$54.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.62
|
| Rate for Payer: Nomi Health Commercial |
$49.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.44
|
|
|
HC OSTEOPATHIC MANIPULATION 7-8 BODY REGIONS
|
Facility
|
OP
|
$60.73
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
53000004
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$60.73 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: Aetna Medicare |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$58.91
|
| Rate for Payer: ASR Commercial |
$58.91
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$49.73
|
| Rate for Payer: BCN Commercial |
$47.08
|
| Rate for Payer: BCN Medicare Advantage |
$24.67
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cofinity Commercial |
$57.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$58.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.67
|
| Rate for Payer: Mclaren Commercial |
$54.66
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$24.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.62
|
| Rate for Payer: Nomi Health Commercial |
$49.80
|
| Rate for Payer: PACE Medicare |
$23.44
|
| Rate for Payer: PACE SWMI |
$24.67
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicaid |
$13.22
|
| Rate for Payer: PHP Medicare Advantage |
$24.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.21
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow Network |
$42.57
|
| Rate for Payer: Railroad Medicare Medicare |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.67
|
| Rate for Payer: UHC Exchange |
$38.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.67
|
| Rate for Payer: UHCCP DNSP |
$24.67
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$24.67
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
IP
|
$65.61
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$65.61 |
| Rate for Payer: Aetna Commercial |
$59.05
|
| Rate for Payer: ASR ASR |
$63.64
|
| Rate for Payer: ASR Commercial |
$63.64
|
| Rate for Payer: BCBS Trust/PPO |
$53.47
|
| Rate for Payer: BCN Commercial |
$50.87
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cofinity Commercial |
$61.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.49
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Healthscope Whirlpool |
$63.64
|
| Rate for Payer: Mclaren Commercial |
$59.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.77
|
| Rate for Payer: Nomi Health Commercial |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.74
|
|
|
HC OSTEOPATHIC MANIPULATION 9-10 BODY REGIONS
|
Facility
|
OP
|
$65.61
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
53000005
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$65.61 |
| Rate for Payer: Aetna Commercial |
$59.05
|
| Rate for Payer: Aetna Medicare |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.84
|
| Rate for Payer: ASR ASR |
$63.64
|
| Rate for Payer: ASR Commercial |
$63.64
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$53.73
|
| Rate for Payer: BCN Commercial |
$50.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.67
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Cofinity Commercial |
$61.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Healthscope Whirlpool |
$63.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.67
|
| Rate for Payer: Mclaren Commercial |
$59.05
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$24.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.77
|
| Rate for Payer: Nomi Health Commercial |
$53.80
|
| Rate for Payer: PACE Medicare |
$23.44
|
| Rate for Payer: PACE SWMI |
$24.67
|
| Rate for Payer: PHP Commercial |
$27.14
|
| Rate for Payer: PHP Medicaid |
$13.22
|
| Rate for Payer: PHP Medicare Advantage |
$24.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.49
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow Network |
$45.99
|
| Rate for Payer: Railroad Medicare Medicare |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.67
|
| Rate for Payer: UHC Exchange |
$38.24
|
| Rate for Payer: UHC Medicare Advantage |
$24.67
|
| Rate for Payer: UHCCP DNSP |
$24.67
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$24.67
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
OP
|
$1,988.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.46 |
| Max. Negotiated Rate |
$1,988.64 |
| Rate for Payer: Aetna Commercial |
$1,789.78
|
| Rate for Payer: Aetna Medicare |
$994.32
|
| Rate for Payer: ASR ASR |
$1,928.98
|
| Rate for Payer: ASR Commercial |
$1,928.98
|
| Rate for Payer: BCBS Complete |
$795.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.50
|
| Rate for Payer: BCN Commercial |
$1,541.79
|
| Rate for Payer: Cash Price |
$1,590.91
|
| Rate for Payer: Cofinity Commercial |
$1,869.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.91
|
| Rate for Payer: Healthscope Commercial |
$1,988.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,928.98
|
| Rate for Payer: Mclaren Commercial |
$1,789.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,690.34
|
| Rate for Payer: Nomi Health Commercial |
$1,630.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,742.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,394.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.00
|
|
|
HC OSTIAL PRO SYSTEM
|
Facility
|
IP
|
$1,988.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,292.62 |
| Max. Negotiated Rate |
$1,988.64 |
| Rate for Payer: Aetna Commercial |
$1,789.78
|
| Rate for Payer: ASR ASR |
$1,928.98
|
| Rate for Payer: ASR Commercial |
$1,928.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.54
|
| Rate for Payer: BCN Commercial |
$1,541.79
|
| Rate for Payer: Cash Price |
$1,590.91
|
| Rate for Payer: Cofinity Commercial |
$1,869.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.91
|
| Rate for Payer: Healthscope Commercial |
$1,988.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,928.98
|
| Rate for Payer: Mclaren Commercial |
$1,789.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,690.34
|
| Rate for Payer: Nomi Health Commercial |
$1,630.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.00
|
|
|
HC OSTO-ZYME
|
Facility
|
OP
|
$43.10
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$43.10 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$21.55
|
| Rate for Payer: ASR ASR |
$41.81
|
| Rate for Payer: ASR Commercial |
$41.81
|
| Rate for Payer: BCBS Complete |
$17.24
|
| Rate for Payer: BCBS Trust/PPO |
$35.29
|
| Rate for Payer: BCN Commercial |
$33.42
|
| Rate for Payer: Cash Price |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$40.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.48
|
| Rate for Payer: Healthscope Commercial |
$43.10
|
| Rate for Payer: Healthscope Whirlpool |
$41.81
|
| Rate for Payer: Mclaren Commercial |
$38.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.63
|
| Rate for Payer: Nomi Health Commercial |
$35.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.76
|
| Rate for Payer: Priority Health Narrow Network |
$30.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.93
|
|
|
HC OSTO-ZYME
|
Facility
|
IP
|
$43.10
|
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$43.10 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: ASR ASR |
$41.81
|
| Rate for Payer: ASR Commercial |
$41.81
|
| Rate for Payer: BCBS Trust/PPO |
$35.12
|
| Rate for Payer: BCN Commercial |
$33.42
|
| Rate for Payer: Cash Price |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$40.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.48
|
| Rate for Payer: Healthscope Commercial |
$43.10
|
| Rate for Payer: Healthscope Whirlpool |
$41.81
|
| Rate for Payer: Mclaren Commercial |
$38.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.63
|
| Rate for Payer: Nomi Health Commercial |
$35.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.93
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC OSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$279.25
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$111.70 |
| Max. Negotiated Rate |
$279.25 |
| Rate for Payer: Aetna Commercial |
$251.32
|
| Rate for Payer: Aetna Medicare |
$139.62
|
| Rate for Payer: ASR ASR |
$270.87
|
| Rate for Payer: ASR Commercial |
$270.87
|
| Rate for Payer: BCBS Complete |
$111.70
|
| Rate for Payer: BCBS Trust/PPO |
$228.68
|
| Rate for Payer: BCN Commercial |
$216.50
|
| Rate for Payer: Cash Price |
$223.40
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.40
|
| Rate for Payer: Healthscope Commercial |
$279.25
|
| Rate for Payer: Healthscope Whirlpool |
$270.87
|
| Rate for Payer: Mclaren Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.36
|
| Rate for Payer: Nomi Health Commercial |
$228.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.68
|
| Rate for Payer: Priority Health Narrow Network |
$195.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.74
|
|
|
HC OT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$279.25
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
43400009
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$181.51 |
| Max. Negotiated Rate |
$279.25 |
| Rate for Payer: Aetna Commercial |
$251.32
|
| Rate for Payer: ASR ASR |
$270.87
|
| Rate for Payer: ASR Commercial |
$270.87
|
| Rate for Payer: BCBS Trust/PPO |
$227.56
|
| Rate for Payer: BCN Commercial |
$216.50
|
| Rate for Payer: Cash Price |
$223.40
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.40
|
| Rate for Payer: Healthscope Commercial |
$279.25
|
| Rate for Payer: Healthscope Whirlpool |
$270.87
|
| Rate for Payer: Mclaren Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.36
|
| Rate for Payer: Nomi Health Commercial |
$228.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.74
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$228.47
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$205.62
|
| Rate for Payer: ASR ASR |
$221.62
|
| Rate for Payer: ASR Commercial |
$221.62
|
| Rate for Payer: BCBS Trust/PPO |
$186.18
|
| Rate for Payer: BCN Commercial |
$177.13
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$214.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.78
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Healthscope Whirlpool |
$221.62
|
| Rate for Payer: Mclaren Commercial |
$205.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.20
|
| Rate for Payer: Nomi Health Commercial |
$187.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.05
|
|
|
HC OT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$228.47
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
43400007
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$205.62
|
| Rate for Payer: Aetna Medicare |
$114.23
|
| Rate for Payer: ASR ASR |
$221.62
|
| Rate for Payer: ASR Commercial |
$221.62
|
| Rate for Payer: BCBS Complete |
$91.39
|
| Rate for Payer: BCBS Trust/PPO |
$187.09
|
| Rate for Payer: BCN Commercial |
$177.13
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$214.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.78
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Healthscope Whirlpool |
$221.62
|
| Rate for Payer: Mclaren Commercial |
$205.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.20
|
| Rate for Payer: Nomi Health Commercial |
$187.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.19
|
| Rate for Payer: Priority Health Narrow Network |
$160.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.05
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$253.86 |
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: Aetna Medicare |
$126.93
|
| Rate for Payer: ASR ASR |
$246.24
|
| Rate for Payer: ASR Commercial |
$246.24
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$207.89
|
| Rate for Payer: BCN Commercial |
$196.82
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$238.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$253.86
|
| Rate for Payer: Healthscope Whirlpool |
$246.24
|
| Rate for Payer: Mclaren Commercial |
$228.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.43
|
| Rate for Payer: Priority Health Narrow Network |
$177.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.40
|
|
|
HC OT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
43400008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$253.86 |
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: ASR ASR |
$246.24
|
| Rate for Payer: ASR Commercial |
$246.24
|
| Rate for Payer: BCBS Trust/PPO |
$206.87
|
| Rate for Payer: BCN Commercial |
$196.82
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$238.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$253.86
|
| Rate for Payer: Healthscope Whirlpool |
$246.24
|
| Rate for Payer: Mclaren Commercial |
$228.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.40
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: ASR Commercial |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$98.08
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.31
|
| Rate for Payer: Nomi Health Commercial |
$98.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
43400010
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Aetna Commercial |
$108.32
|
| Rate for Payer: Aetna Medicare |
$60.18
|
| Rate for Payer: ASR ASR |
$116.75
|
| Rate for Payer: ASR Commercial |
$116.75
|
| Rate for Payer: BCBS Complete |
$48.14
|
| Rate for Payer: BCBS Trust/PPO |
$98.56
|
| Rate for Payer: BCN Commercial |
$93.32
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$120.36
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Mclaren Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.31
|
| Rate for Payer: Nomi Health Commercial |
$98.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.46
|
| Rate for Payer: Priority Health Narrow Network |
$84.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.92
|
|
|
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 |
$66.30 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: ASR Commercial |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
