|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$231.75 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: Aetna Medicare |
$66.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.47
|
| Rate for Payer: BCBS Complete |
$103.00
|
| Rate for Payer: BCBS MAPPO |
$64.38
|
| Rate for Payer: BCBS Trust/PPO |
$211.69
|
| Rate for Payer: BCN Commercial |
$200.21
|
| Rate for Payer: BCN Medicare Advantage |
$64.38
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.38
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: PACE Senior Care Partners |
$61.16
|
| Rate for Payer: PACE SWMI |
$64.38
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: PHP Medicare Advantage |
$64.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health HMO/PPO |
$224.03
|
| Rate for Payer: Priority Health Medicare |
$65.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.53
|
| Rate for Payer: Railroad Medicare Medicare |
$64.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.60
|
| Rate for Payer: UHC Core |
$215.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.38
|
| Rate for Payer: UHC Exchange |
$64.38
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$64.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.12
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$235.21
|
| Rate for Payer: BCN Commercial |
$222.45
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.69
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$71.53
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$185.97 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: BCBS Trust/PPO |
$233.55
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: BCBS Trust/PPO |
$57.50
|
| Rate for Payer: BCN Commercial |
$54.44
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$60.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| Rate for Payer: PHP Commercial |
$59.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health HMO/PPO |
$61.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.99
|
| Rate for Payer: UHC Core |
$58.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.83
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$63.40 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.01
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$17.61
|
| Rate for Payer: BCBS Trust/PPO |
$57.91
|
| Rate for Payer: BCN Commercial |
$54.77
|
| Rate for Payer: BCN Medicare Advantage |
$17.61
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$60.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.61
|
| Rate for Payer: Healthscope Commercial |
$63.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.83
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.49
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| Rate for Payer: PACE Senior Care Partners |
$16.73
|
| Rate for Payer: PACE SWMI |
$17.61
|
| Rate for Payer: PHP Commercial |
$59.87
|
| Rate for Payer: PHP Medicare Advantage |
$17.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health HMO/PPO |
$61.28
|
| Rate for Payer: Priority Health Medicare |
$17.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.19
|
| Rate for Payer: Railroad Medicare Medicare |
$17.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.99
|
| Rate for Payer: UHC Core |
$58.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.61
|
| Rate for Payer: UHC Exchange |
$17.61
|
| Rate for Payer: UHC Medicare Advantage |
$17.61
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$17.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.83
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna Commercial |
$82.57
|
| Rate for Payer: Aetna Medicare |
$25.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.36
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS MAPPO |
$24.29
|
| Rate for Payer: BCBS Trust/PPO |
$79.86
|
| Rate for Payer: BCN Commercial |
$75.53
|
| Rate for Payer: BCN Medicare Advantage |
$24.29
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.29
|
| Rate for Payer: Healthscope Commercial |
$87.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: PACE Senior Care Partners |
$23.07
|
| Rate for Payer: PACE SWMI |
$24.29
|
| Rate for Payer: PHP Commercial |
$82.57
|
| Rate for Payer: PHP Medicare Advantage |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health HMO/PPO |
$84.51
|
| Rate for Payer: Priority Health Medicare |
$24.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.08
|
| Rate for Payer: Railroad Medicare Medicare |
$24.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.48
|
| Rate for Payer: UHC Core |
$81.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.29
|
| Rate for Payer: UHC Exchange |
$24.29
|
| Rate for Payer: UHC Medicare Advantage |
$24.29
|
| Rate for Payer: VA VA |
$24.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.86
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna Commercial |
$82.57
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$75.07
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$87.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: PHP Commercial |
$82.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health HMO/PPO |
$84.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.48
|
| Rate for Payer: UHC Core |
$81.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.86
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$115.34 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.05
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS MAPPO |
$32.04
|
| Rate for Payer: BCBS Trust/PPO |
$105.36
|
| Rate for Payer: BCN Commercial |
$99.64
|
| Rate for Payer: BCN Medicare Advantage |
$32.04
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.04
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: PACE Senior Care Partners |
$30.44
|
| Rate for Payer: PACE SWMI |
$32.04
|
| Rate for Payer: PHP Commercial |
$108.94
|
| Rate for Payer: PHP Medicare Advantage |
$32.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO |
$111.50
|
| Rate for Payer: Priority Health Medicare |
$32.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.87
|
| Rate for Payer: Railroad Medicare Medicare |
$32.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.78
|
| Rate for Payer: UHC Core |
$107.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.04
|
| Rate for Payer: UHC Exchange |
$32.04
|
| Rate for Payer: UHC Medicare Advantage |
$32.04
|
| Rate for Payer: VA VA |
$32.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.12
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$115.34 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: BCBS Trust/PPO |
$104.62
|
| Rate for Payer: BCN Commercial |
$99.04
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: PHP Commercial |
$108.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO |
$111.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.78
|
| Rate for Payer: UHC Core |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.12
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: BCBS Trust/PPO |
$71.57
|
| Rate for Payer: BCN Commercial |
$67.76
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC PULM EXER FUNCTION INDIV 15 MIN
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0238
|
| Hospital Charge Code |
41000045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.40
|
| Rate for Payer: BCBS Complete |
$18.59
|
| Rate for Payer: BCBS MAPPO |
$21.92
|
| Rate for Payer: BCBS Trust/PPO |
$72.08
|
| Rate for Payer: BCN Commercial |
$68.17
|
| Rate for Payer: BCN Medicare Advantage |
$21.92
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.02
|
| Rate for Payer: Meridian Medicaid |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PACE Senior Care Partners |
$20.82
|
| Rate for Payer: PACE SWMI |
$21.92
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$21.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.75
|
| Rate for Payer: Railroad Medicare Medicare |
$21.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.92
|
| Rate for Payer: UHC Exchange |
$21.92
|
| Rate for Payer: UHC Medicare Advantage |
$21.92
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$21.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
IP
|
$1,701.19
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,105.77 |
| Max. Negotiated Rate |
$1,531.07 |
| Rate for Payer: Aetna Commercial |
$1,446.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.68
|
| Rate for Payer: BCN Commercial |
$1,314.68
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,463.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Healthscope Commercial |
$1,531.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: Nomi Health Commercial |
$1,394.98
|
| Rate for Payer: PHP Commercial |
$1,446.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,480.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,139.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,497.05
|
| Rate for Payer: UHC Core |
$1,420.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.89
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,701.19
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.03 |
| Max. Negotiated Rate |
$2,389.58 |
| Rate for Payer: Aetna Commercial |
$1,446.01
|
| Rate for Payer: Aetna Medicare |
$442.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$531.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$531.62
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$425.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,398.55
|
| Rate for Payer: BCN Commercial |
$1,322.68
|
| Rate for Payer: BCN Medicare Advantage |
$425.30
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,463.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.30
|
| Rate for Payer: Healthscope Commercial |
$1,531.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.89
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.56
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$489.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: Nomi Health Commercial |
$1,394.98
|
| Rate for Payer: PACE Senior Care Partners |
$404.03
|
| Rate for Payer: PACE SWMI |
$425.30
|
| Rate for Payer: PHP Commercial |
$1,446.01
|
| Rate for Payer: PHP Medicare Advantage |
$425.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,480.04
|
| Rate for Payer: Priority Health Medicare |
$429.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,139.80
|
| Rate for Payer: Railroad Medicare Medicare |
$425.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,497.05
|
| Rate for Payer: UHC Core |
$1,420.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.30
|
| Rate for Payer: UHC Exchange |
$425.30
|
| Rate for Payer: UHC Medicare Advantage |
$425.30
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$425.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.89
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$105.20
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.88
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$26.30
|
| Rate for Payer: BCBS Trust/PPO |
$86.48
|
| Rate for Payer: BCN Commercial |
$81.79
|
| Rate for Payer: BCN Medicare Advantage |
$26.30
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.30
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.90
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.61
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: Nomi Health Commercial |
$86.26
|
| Rate for Payer: PACE Senior Care Partners |
$24.98
|
| Rate for Payer: PACE SWMI |
$26.30
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: PHP Medicare Advantage |
$26.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: Priority Health HMO/PPO |
$91.52
|
| Rate for Payer: Priority Health Medicare |
$26.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.58
|
| Rate for Payer: UHC Core |
$87.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.30
|
| Rate for Payer: UHC Exchange |
$26.30
|
| Rate for Payer: UHC Medicare Advantage |
$26.30
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$26.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.90
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
IP
|
$105.20
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna Commercial |
$89.42
|
| Rate for Payer: BCBS Trust/PPO |
$85.87
|
| Rate for Payer: BCN Commercial |
$81.30
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Healthscope Commercial |
$94.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: Nomi Health Commercial |
$86.26
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: Priority Health HMO/PPO |
$91.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.58
|
| Rate for Payer: UHC Core |
$87.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.90
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
OP
|
$371.82
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna Commercial |
$316.05
|
| Rate for Payer: Aetna Medicare |
$96.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.19
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$92.95
|
| Rate for Payer: BCBS Trust/PPO |
$305.67
|
| Rate for Payer: BCN Commercial |
$289.09
|
| Rate for Payer: BCN Medicare Advantage |
$92.95
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$319.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.95
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.87
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: Nomi Health Commercial |
$304.89
|
| Rate for Payer: PACE Senior Care Partners |
$88.31
|
| Rate for Payer: PACE SWMI |
$92.95
|
| Rate for Payer: PHP Commercial |
$316.05
|
| Rate for Payer: PHP Medicare Advantage |
$92.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO |
$323.48
|
| Rate for Payer: Priority Health Medicare |
$93.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.12
|
| Rate for Payer: Railroad Medicare Medicare |
$92.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.20
|
| Rate for Payer: UHC Core |
$310.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.95
|
| Rate for Payer: UHC Exchange |
$92.95
|
| Rate for Payer: UHC Medicare Advantage |
$92.95
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$92.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.87
|
|
|
HC PULMONARY STRESS TESTING (EG 6 MIN WALK)
|
Facility
|
IP
|
$371.82
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
46000030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna Commercial |
$316.05
|
| Rate for Payer: BCBS Trust/PPO |
$303.52
|
| Rate for Payer: BCN Commercial |
$287.34
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$319.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Healthscope Commercial |
$334.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: Nomi Health Commercial |
$304.89
|
| Rate for Payer: PHP Commercial |
$316.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO |
$323.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.20
|
| Rate for Payer: UHC Core |
$310.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.87
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
IP
|
$219.58
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$142.73 |
| Max. Negotiated Rate |
$197.62 |
| Rate for Payer: Aetna Commercial |
$186.64
|
| Rate for Payer: BCBS Trust/PPO |
$179.24
|
| Rate for Payer: BCN Commercial |
$169.69
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$188.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Healthscope Commercial |
$197.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: Nomi Health Commercial |
$180.06
|
| Rate for Payer: PHP Commercial |
$186.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: Priority Health HMO/PPO |
$191.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.23
|
| Rate for Payer: UHC Core |
$183.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.69
|
|
|
HC PULM REHAB W/ CONT OXIMTRY MNTR
|
Facility
|
OP
|
$219.58
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
94800004
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$197.62 |
| Rate for Payer: Aetna Commercial |
$186.64
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.62
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$54.90
|
| Rate for Payer: BCBS Trust/PPO |
$180.52
|
| Rate for Payer: BCN Commercial |
$170.72
|
| Rate for Payer: BCN Medicare Advantage |
$54.90
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$188.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.90
|
| Rate for Payer: Healthscope Commercial |
$197.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.69
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.64
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: Nomi Health Commercial |
$180.06
|
| Rate for Payer: PACE Senior Care Partners |
$52.15
|
| Rate for Payer: PACE SWMI |
$54.90
|
| Rate for Payer: PHP Commercial |
$186.64
|
| Rate for Payer: PHP Medicare Advantage |
$54.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: Priority Health HMO/PPO |
$191.03
|
| Rate for Payer: Priority Health Medicare |
$55.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.12
|
| Rate for Payer: Railroad Medicare Medicare |
$54.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.23
|
| Rate for Payer: UHC Core |
$183.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.90
|
| Rate for Payer: UHC Exchange |
$54.90
|
| Rate for Payer: UHC Medicare Advantage |
$54.90
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$54.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.69
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
OP
|
$186.64
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$158.64
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$153.44
|
| Rate for Payer: BCN Commercial |
$145.11
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cofinity Commercial |
$160.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$167.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.98
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.64
|
| Rate for Payer: Nomi Health Commercial |
$153.04
|
| Rate for Payer: PACE Senior Care Partners |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$158.64
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.32
|
| Rate for Payer: Priority Health HMO/PPO |
$162.38
|
| Rate for Payer: Priority Health Medicare |
$47.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.05
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.24
|
| Rate for Payer: UHC Core |
$155.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.66
|
| Rate for Payer: UHC Exchange |
$46.66
|
| Rate for Payer: UHC Medicare Advantage |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$46.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.98
|
|
|
HC PULM REHAB W/O CONT OXIMTRY MNTR
|
Facility
|
IP
|
$186.64
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
94800003
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$121.32 |
| Max. Negotiated Rate |
$167.98 |
| Rate for Payer: Aetna Commercial |
$158.64
|
| Rate for Payer: BCBS Trust/PPO |
$152.35
|
| Rate for Payer: BCN Commercial |
$144.24
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cofinity Commercial |
$160.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.31
|
| Rate for Payer: Healthscope Commercial |
$167.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.64
|
| Rate for Payer: Nomi Health Commercial |
$153.04
|
| Rate for Payer: PHP Commercial |
$158.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.32
|
| Rate for Payer: Priority Health HMO/PPO |
$162.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.24
|
| Rate for Payer: UHC Core |
$155.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.98
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
OP
|
$128.24
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: Aetna Medicare |
$33.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.08
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: BCBS MAPPO |
$32.06
|
| Rate for Payer: BCBS Trust/PPO |
$105.43
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: BCN Medicare Advantage |
$32.06
|
| Rate for Payer: Cash Price |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$110.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.00
|
| Rate for Payer: Nomi Health Commercial |
$105.16
|
| Rate for Payer: PACE Senior Care Partners |
$30.46
|
| Rate for Payer: PACE SWMI |
$32.06
|
| Rate for Payer: PHP Commercial |
$109.00
|
| Rate for Payer: PHP Medicare Advantage |
$32.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO |
$111.57
|
| Rate for Payer: Priority Health Medicare |
$32.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: Railroad Medicare Medicare |
$32.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.85
|
| Rate for Payer: UHC Core |
$107.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.06
|
| Rate for Payer: UHC Exchange |
$32.06
|
| Rate for Payer: UHC Medicare Advantage |
$32.06
|
| Rate for Payer: VA VA |
$32.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.18
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
IP
|
$128.24
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.36 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: BCBS Trust/PPO |
$104.68
|
| Rate for Payer: BCN Commercial |
$99.10
|
| Rate for Payer: Cash Price |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$110.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.59
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.00
|
| Rate for Payer: Nomi Health Commercial |
$105.16
|
| Rate for Payer: PHP Commercial |
$109.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO |
$111.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.85
|
| Rate for Payer: UHC Core |
$107.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.18
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
OP
|
$205.42
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$184.88 |
| Rate for Payer: Aetna Commercial |
$174.61
|
| Rate for Payer: Aetna Medicare |
$53.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.19
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$51.35
|
| Rate for Payer: BCBS Trust/PPO |
$168.88
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: BCN Medicare Advantage |
$51.35
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$176.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.35
|
| Rate for Payer: Healthscope Commercial |
$184.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.06
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.92
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.61
|
| Rate for Payer: Nomi Health Commercial |
$168.44
|
| Rate for Payer: PACE Senior Care Partners |
$48.79
|
| Rate for Payer: PACE SWMI |
$51.35
|
| Rate for Payer: PHP Commercial |
$174.61
|
| Rate for Payer: PHP Medicare Advantage |
$51.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health HMO/PPO |
$178.72
|
| Rate for Payer: Priority Health Medicare |
$51.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.63
|
| Rate for Payer: Railroad Medicare Medicare |
$51.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.77
|
| Rate for Payer: UHC Core |
$171.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.35
|
| Rate for Payer: UHC Exchange |
$51.35
|
| Rate for Payer: UHC Medicare Advantage |
$51.35
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$51.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.06
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
IP
|
$205.42
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$184.88 |
| Rate for Payer: Aetna Commercial |
$174.61
|
| Rate for Payer: BCBS Trust/PPO |
$167.68
|
| Rate for Payer: BCN Commercial |
$158.75
|
| Rate for Payer: Cash Price |
$164.34
|
| Rate for Payer: Cofinity Commercial |
$176.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.34
|
| Rate for Payer: Healthscope Commercial |
$184.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.61
|
| Rate for Payer: Nomi Health Commercial |
$168.44
|
| Rate for Payer: PHP Commercial |
$174.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health HMO/PPO |
$178.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.77
|
| Rate for Payer: UHC Core |
$171.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.06
|
|
