|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$218.09
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.08
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$72.23
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: BCBS Trust/PPO |
$53.37
|
| Rate for Payer: BCN Commercial |
$53.37
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$59.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.25
|
| Rate for Payer: Healthscope Commercial |
$62.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: PHP Commercial |
$58.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.77
|
| Rate for Payer: UHC Core |
$57.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.80
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.58
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: BCBS MAPPO |
$17.26
|
| Rate for Payer: BCBS Trust/PPO |
$53.69
|
| Rate for Payer: BCN Commercial |
$53.69
|
| Rate for Payer: BCN Medicare Advantage |
$17.26
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$59.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$62.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.80
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Meridian Medicaid |
$3.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: PACE Senior Care Partners |
$16.40
|
| Rate for Payer: PACE SWMI |
$17.26
|
| Rate for Payer: PHP Commercial |
$58.70
|
| Rate for Payer: PHP Medicare Advantage |
$17.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.08
|
| Rate for Payer: Priority Health Medicare |
$17.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.77
|
| Rate for Payer: UHC Core |
$57.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.26
|
| Rate for Payer: UHC Medicare Advantage |
$17.78
|
| Rate for Payer: VA VA |
$17.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.80
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$80.95
|
| Rate for Payer: BCBS Trust/PPO |
$73.60
|
| Rate for Payer: BCN Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.19
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: PHP Commercial |
$80.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.81
|
| Rate for Payer: UHC Core |
$79.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.43
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Aetna Commercial |
$80.95
|
| Rate for Payer: Aetna Medicare |
$24.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.76
|
| Rate for Payer: BCBS Complete |
$38.10
|
| Rate for Payer: BCBS MAPPO |
$23.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.05
|
| Rate for Payer: BCN Commercial |
$74.05
|
| Rate for Payer: BCN Medicare Advantage |
$23.81
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$85.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: PACE Senior Care Partners |
$22.62
|
| Rate for Payer: PACE SWMI |
$23.81
|
| Rate for Payer: PHP Commercial |
$80.95
|
| Rate for Payer: PHP Medicare Advantage |
$23.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.86
|
| Rate for Payer: Priority Health Medicare |
$23.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$23.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.81
|
| Rate for Payer: UHC Core |
$79.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.81
|
| Rate for Payer: UHC Medicare Advantage |
$24.52
|
| Rate for Payer: VA VA |
$23.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.43
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$76.63 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: BCBS Trust/PPO |
$97.10
|
| Rate for Payer: BCN Commercial |
$97.10
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.52
|
| Rate for Payer: Healthscope Commercial |
$113.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: PHP Commercial |
$106.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.57
|
| Rate for Payer: UHC Core |
$104.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.24
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna Medicare |
$32.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.27
|
| Rate for Payer: BCBS Complete |
$50.26
|
| Rate for Payer: BCBS MAPPO |
$31.41
|
| Rate for Payer: BCBS Trust/PPO |
$97.69
|
| Rate for Payer: BCN Commercial |
$97.69
|
| Rate for Payer: BCN Medicare Advantage |
$31.41
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$113.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: PACE Senior Care Partners |
$29.84
|
| Rate for Payer: PACE SWMI |
$31.41
|
| Rate for Payer: PHP Commercial |
$106.80
|
| Rate for Payer: PHP Medicare Advantage |
$31.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.32
|
| Rate for Payer: Priority Health Medicare |
$31.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.63
|
| Rate for Payer: Railroad Medicare Medicare |
$31.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.57
|
| Rate for Payer: UHC Core |
$104.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.41
|
| Rate for Payer: UHC Medicare Advantage |
$32.35
|
| Rate for Payer: VA VA |
$31.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.24
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: BCBS Trust/PPO |
$66.43
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Core |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna Medicare |
$22.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.86
|
| Rate for Payer: BCBS Complete |
$20.51
|
| Rate for Payer: BCBS MAPPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$66.83
|
| Rate for Payer: BCN Commercial |
$66.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.49
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.49
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Mclaren Medicaid |
$19.53
|
| Rate for Payer: Meridian Medicaid |
$20.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PACE Senior Care Partners |
$20.42
|
| Rate for Payer: PACE SWMI |
$21.49
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: PHP Medicare Advantage |
$21.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.79
|
| Rate for Payer: Priority Health Medicare |
$21.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.43
|
| Rate for Payer: Railroad Medicare Medicare |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Core |
$71.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.49
|
| Rate for Payer: UHC Medicare Advantage |
$22.13
|
| Rate for Payer: VA VA |
$21.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
IP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,017.21 |
| Max. Negotiated Rate |
$1,501.05 |
| Rate for Payer: Aetna Commercial |
$1,417.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.90
|
| Rate for Payer: BCN Commercial |
$1,288.90
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,434.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.26
|
| Rate for Payer: Healthscope Commercial |
$1,501.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,250.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: PHP Commercial |
$1,417.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,451.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,017.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,467.69
|
| Rate for Payer: UHC Core |
$1,392.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,250.87
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.11 |
| Max. Negotiated Rate |
$2,195.52 |
| Rate for Payer: Aetna Commercial |
$1,417.66
|
| Rate for Payer: Aetna Medicare |
$433.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.20
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$416.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.74
|
| Rate for Payer: BCN Commercial |
$1,296.74
|
| Rate for Payer: BCN Medicare Advantage |
$416.96
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,434.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.96
|
| Rate for Payer: Healthscope Commercial |
$1,501.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,250.87
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: PACE Senior Care Partners |
$396.11
|
| Rate for Payer: PACE SWMI |
$416.96
|
| Rate for Payer: PHP Commercial |
$1,417.66
|
| Rate for Payer: PHP Medicare Advantage |
$416.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,451.01
|
| Rate for Payer: Priority Health Medicare |
$416.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,017.21
|
| Rate for Payer: Railroad Medicare Medicare |
$416.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,467.69
|
| Rate for Payer: UHC Core |
$1,392.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.96
|
| Rate for Payer: UHC Medicare Advantage |
$429.47
|
| Rate for Payer: VA VA |
$416.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,250.87
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
IP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.91 |
| Max. Negotiated Rate |
$92.83 |
| Rate for Payer: Aetna Commercial |
$87.67
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Commercial |
$79.71
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.51
|
| Rate for Payer: Healthscope Commercial |
$92.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: PHP Commercial |
$87.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.76
|
| Rate for Payer: UHC Core |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.36
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$92.83 |
| Rate for Payer: Aetna Commercial |
$87.67
|
| Rate for Payer: Aetna Medicare |
$26.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.23
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$25.78
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$80.19
|
| Rate for Payer: BCN Medicare Advantage |
$25.78
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.78
|
| Rate for Payer: Healthscope Commercial |
$92.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.36
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: PACE Senior Care Partners |
$24.50
|
| Rate for Payer: PACE SWMI |
$25.78
|
| Rate for Payer: PHP Commercial |
$87.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.73
|
| Rate for Payer: Priority Health Medicare |
$25.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.91
|
| Rate for Payer: Railroad Medicare Medicare |
$25.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.76
|
| Rate for Payer: UHC Core |
$86.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.78
|
| Rate for Payer: UHC Medicare Advantage |
$26.56
|
| Rate for Payer: VA VA |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.36
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.92
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$283.42
|
| Rate for Payer: BCN Commercial |
$283.42
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.85
|
| Rate for Payer: PACE Senior Care Partners |
$86.58
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.14
|
| Rate for Payer: Priority Health Medicare |
$91.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.33
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.13
|
| Rate for Payer: UHC Medicare Advantage |
$93.87
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$222.33 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: BCBS Trust/PPO |
$281.71
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.85
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
IP
|
$182.98
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: BCBS Trust/PPO |
$141.41
|
| Rate for Payer: BCN Commercial |
$141.41
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$157.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PHP Commercial |
$155.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.02
|
| Rate for Payer: UHC Core |
$152.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.24
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
OP
|
$182.98
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: Aetna Medicare |
$47.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.18
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$45.74
|
| Rate for Payer: BCBS Trust/PPO |
$142.27
|
| Rate for Payer: BCN Commercial |
$142.27
|
| Rate for Payer: BCN Medicare Advantage |
$45.74
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$157.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.74
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.24
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PACE Senior Care Partners |
$43.46
|
| Rate for Payer: PACE SWMI |
$45.74
|
| Rate for Payer: PHP Commercial |
$155.53
|
| Rate for Payer: PHP Medicare Advantage |
$45.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.19
|
| Rate for Payer: Priority Health Medicare |
$45.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.02
|
| Rate for Payer: UHC Core |
$152.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.74
|
| Rate for Payer: UHC Medicare Advantage |
$47.12
|
| Rate for Payer: VA VA |
$45.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.24
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
OP
|
$182.98
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: Aetna Medicare |
$47.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.18
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$45.74
|
| Rate for Payer: BCBS Trust/PPO |
$142.27
|
| Rate for Payer: BCN Commercial |
$142.27
|
| Rate for Payer: BCN Medicare Advantage |
$45.74
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$157.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.74
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.24
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PACE Senior Care Partners |
$43.46
|
| Rate for Payer: PACE SWMI |
$45.74
|
| Rate for Payer: PHP Commercial |
$155.53
|
| Rate for Payer: PHP Medicare Advantage |
$45.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.19
|
| Rate for Payer: Priority Health Medicare |
$45.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.02
|
| Rate for Payer: UHC Core |
$152.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.74
|
| Rate for Payer: UHC Medicare Advantage |
$47.12
|
| Rate for Payer: VA VA |
$45.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.24
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
IP
|
$182.98
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: BCBS Trust/PPO |
$141.41
|
| Rate for Payer: BCN Commercial |
$141.41
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$157.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PHP Commercial |
$155.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.02
|
| Rate for Payer: UHC Core |
$152.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.24
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
IP
|
$125.73
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$106.87
|
| Rate for Payer: BCBS Trust/PPO |
$97.16
|
| Rate for Payer: BCN Commercial |
$97.16
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.58
|
| Rate for Payer: Healthscope Commercial |
$113.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.87
|
| Rate for Payer: PHP Commercial |
$106.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.64
|
| Rate for Payer: UHC Core |
$104.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.30
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
OP
|
$125.73
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$106.87
|
| Rate for Payer: Aetna Medicare |
$32.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.29
|
| Rate for Payer: BCBS Complete |
$50.29
|
| Rate for Payer: BCBS MAPPO |
$31.43
|
| Rate for Payer: BCBS Trust/PPO |
$97.76
|
| Rate for Payer: BCN Commercial |
$97.76
|
| Rate for Payer: BCN Medicare Advantage |
$31.43
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.43
|
| Rate for Payer: Healthscope Commercial |
$113.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.87
|
| Rate for Payer: PACE Senior Care Partners |
$29.86
|
| Rate for Payer: PACE SWMI |
$31.43
|
| Rate for Payer: PHP Commercial |
$106.87
|
| Rate for Payer: PHP Medicare Advantage |
$31.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.39
|
| Rate for Payer: Priority Health Medicare |
$31.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.68
|
| Rate for Payer: Railroad Medicare Medicare |
$31.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.64
|
| Rate for Payer: UHC Core |
$104.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.43
|
| Rate for Payer: UHC Medicare Advantage |
$32.38
|
| Rate for Payer: VA VA |
$31.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.30
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
OP
|
$201.39
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$181.25 |
| Rate for Payer: Aetna Commercial |
$171.18
|
| Rate for Payer: Aetna Medicare |
$52.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.93
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$50.35
|
| Rate for Payer: BCBS Trust/PPO |
$156.58
|
| Rate for Payer: BCN Commercial |
$156.58
|
| Rate for Payer: BCN Medicare Advantage |
$50.35
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$181.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.04
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.18
|
| Rate for Payer: PACE Senior Care Partners |
$47.83
|
| Rate for Payer: PACE SWMI |
$50.35
|
| Rate for Payer: PHP Commercial |
$171.18
|
| Rate for Payer: PHP Medicare Advantage |
$50.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.21
|
| Rate for Payer: Priority Health Medicare |
$50.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.83
|
| Rate for Payer: Railroad Medicare Medicare |
$50.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.22
|
| Rate for Payer: UHC Core |
$168.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.35
|
| Rate for Payer: UHC Medicare Advantage |
$51.86
|
| Rate for Payer: VA VA |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.04
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
IP
|
$201.39
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$122.83 |
| Max. Negotiated Rate |
$181.25 |
| Rate for Payer: Aetna Commercial |
$171.18
|
| Rate for Payer: BCBS Trust/PPO |
$155.63
|
| Rate for Payer: BCN Commercial |
$155.63
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.11
|
| Rate for Payer: Healthscope Commercial |
$181.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.18
|
| Rate for Payer: PHP Commercial |
$171.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.22
|
| Rate for Payer: UHC Core |
$168.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.04
|
|
|
HC PULSE OX SINGLE
|
Facility
|
OP
|
$84.74
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: Aetna Medicare |
$22.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.48
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: BCBS MAPPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$65.89
|
| Rate for Payer: BCN Commercial |
$65.89
|
| Rate for Payer: BCN Medicare Advantage |
$21.18
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.03
|
| Rate for Payer: PACE Senior Care Partners |
$20.13
|
| Rate for Payer: PACE SWMI |
$21.18
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: PHP Medicare Advantage |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.72
|
| Rate for Payer: Priority Health Medicare |
$21.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.68
|
| Rate for Payer: Railroad Medicare Medicare |
$21.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$70.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.18
|
| Rate for Payer: UHC Medicare Advantage |
$21.82
|
| Rate for Payer: VA VA |
$21.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
|
HC PULSE OX SINGLE
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$51.68 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: BCBS Trust/PPO |
$65.49
|
| Rate for Payer: BCN Commercial |
$65.49
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.03
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$70.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
