|
HC PT MIX 1:1
|
Facility
|
OP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$69.06 |
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.92
|
| Rate for Payer: ASR ASR |
$66.99
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$53.54
|
| Rate for Payer: BCN Commercial |
$53.54
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$64.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$69.06
|
| Rate for Payer: Healthscope Whirlpool |
$66.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$62.15
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.94
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: PACE Medicare |
$3.74
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicaid |
$2.16
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.84
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow Network |
$49.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.77
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$3.94
|
|
|
HC PT MIX 1:1
|
Facility
|
IP
|
$69.06
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$69.06 |
| Rate for Payer: Aetna Commercial |
$62.15
|
| Rate for Payer: ASR ASR |
$66.99
|
| Rate for Payer: BCBS Trust/PPO |
$53.54
|
| Rate for Payer: BCN Commercial |
$53.54
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cofinity Commercial |
$64.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.25
|
| Rate for Payer: Healthscope Commercial |
$69.06
|
| Rate for Payer: Healthscope Whirlpool |
$66.99
|
| Rate for Payer: Mclaren Commercial |
$62.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.77
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$95.24 |
| Rate for Payer: Aetna Commercial |
$85.72
|
| Rate for Payer: ASR ASR |
$92.38
|
| Rate for Payer: BCBS Complete |
$38.10
|
| Rate for Payer: BCBS Trust/PPO |
$73.84
|
| Rate for Payer: BCN Commercial |
$73.84
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$89.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.19
|
| Rate for Payer: Healthscope Commercial |
$95.24
|
| Rate for Payer: Healthscope Whirlpool |
$92.38
|
| Rate for Payer: Mclaren Commercial |
$85.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.05
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.81
|
|
|
HC PT NEUROSTIM
|
Facility
|
IP
|
$95.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$95.24 |
| Rate for Payer: Aetna Commercial |
$85.72
|
| Rate for Payer: ASR ASR |
$92.38
|
| Rate for Payer: BCBS Trust/PPO |
$73.84
|
| Rate for Payer: BCN Commercial |
$73.84
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cofinity Commercial |
$89.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.19
|
| Rate for Payer: Healthscope Commercial |
$95.24
|
| Rate for Payer: Healthscope Whirlpool |
$92.38
|
| Rate for Payer: Mclaren Commercial |
$85.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.81
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$125.65 |
| Rate for Payer: Aetna Commercial |
$113.08
|
| Rate for Payer: ASR ASR |
$121.88
|
| Rate for Payer: BCBS Complete |
$50.26
|
| Rate for Payer: BCBS Trust/PPO |
$97.42
|
| Rate for Payer: BCN Commercial |
$97.42
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$118.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.52
|
| Rate for Payer: Healthscope Commercial |
$125.65
|
| Rate for Payer: Healthscope Whirlpool |
$121.88
|
| Rate for Payer: Mclaren Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.34
|
| Rate for Payer: Priority Health Narrow Network |
$89.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.57
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$125.65
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$125.65 |
| Rate for Payer: Aetna Commercial |
$113.08
|
| Rate for Payer: ASR ASR |
$121.88
|
| Rate for Payer: BCBS Trust/PPO |
$97.42
|
| Rate for Payer: BCN Commercial |
$97.42
|
| Rate for Payer: Cash Price |
$100.52
|
| Rate for Payer: Cofinity Commercial |
$118.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.52
|
| Rate for Payer: Healthscope Commercial |
$125.65
|
| Rate for Payer: Healthscope Whirlpool |
$121.88
|
| Rate for Payer: Mclaren Commercial |
$113.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.57
|
|
|
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 |
$14.48 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.22
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$61.03
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
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 |
$60.17 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: ASR ASR |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$80.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Healthscope Whirlpool |
$83.38
|
| Rate for Payer: Mclaren Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.64
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
IP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.48 |
| Max. Negotiated Rate |
$1,667.83 |
| Rate for Payer: Aetna Commercial |
$1,501.05
|
| Rate for Payer: ASR ASR |
$1,617.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.07
|
| Rate for Payer: BCN Commercial |
$1,293.07
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,567.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.26
|
| Rate for Payer: Healthscope Commercial |
$1,667.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,617.80
|
| Rate for Payer: Mclaren Commercial |
$1,501.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,467.69
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,667.83
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.48 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$1,501.05
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$1,617.80
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.07
|
| Rate for Payer: BCN Commercial |
$1,293.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cash Price |
$1,334.26
|
| Rate for Payer: Cofinity Commercial |
$1,567.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$1,667.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,617.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$1,501.05
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.66
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.73
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,467.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
IP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$103.14 |
| Rate for Payer: Aetna Commercial |
$92.83
|
| Rate for Payer: ASR ASR |
$100.05
|
| Rate for Payer: BCBS Trust/PPO |
$79.96
|
| Rate for Payer: BCN Commercial |
$79.96
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$96.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.51
|
| Rate for Payer: Healthscope Commercial |
$103.14
|
| Rate for Payer: Healthscope Whirlpool |
$100.05
|
| Rate for Payer: Mclaren Commercial |
$92.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.76
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$103.14
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$103.14 |
| Rate for Payer: Aetna Commercial |
$92.83
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$100.05
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$79.96
|
| Rate for Payer: BCN Commercial |
$79.96
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$96.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$103.14
|
| Rate for Payer: Healthscope Whirlpool |
$100.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$92.83
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.67
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.86
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$73.23
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.76
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
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 |
$255.17 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$282.62
|
| Rate for Payer: BCN Commercial |
$282.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Healthscope Whirlpool |
$353.59
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
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 |
$62.11 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$282.62
|
| Rate for Payer: BCN Commercial |
$282.62
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$364.53
|
| Rate for Payer: Healthscope Whirlpool |
$353.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.85
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.38
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$89.90
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
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 |
$128.09 |
| Max. Negotiated Rate |
$182.98 |
| Rate for Payer: Aetna Commercial |
$164.68
|
| Rate for Payer: ASR ASR |
$177.49
|
| Rate for Payer: BCBS Trust/PPO |
$141.86
|
| Rate for Payer: BCN Commercial |
$141.86
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Healthscope Commercial |
$182.98
|
| Rate for Payer: Healthscope Whirlpool |
$177.49
|
| Rate for Payer: Mclaren Commercial |
$164.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.02
|
|
|
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 |
$29.74 |
| Max. Negotiated Rate |
$182.98 |
| Rate for Payer: Aetna Commercial |
$164.68
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$177.49
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$141.86
|
| Rate for Payer: BCN Commercial |
$141.86
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$182.98
|
| Rate for Payer: Healthscope Whirlpool |
$177.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$164.68
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.51
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$129.92
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.02
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
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 |
$128.09 |
| Max. Negotiated Rate |
$182.98 |
| Rate for Payer: Aetna Commercial |
$164.68
|
| Rate for Payer: ASR ASR |
$177.49
|
| Rate for Payer: BCBS Trust/PPO |
$141.86
|
| Rate for Payer: BCN Commercial |
$141.86
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Healthscope Commercial |
$182.98
|
| Rate for Payer: Healthscope Whirlpool |
$177.49
|
| Rate for Payer: Mclaren Commercial |
$164.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.02
|
|
|
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 |
$29.74 |
| Max. Negotiated Rate |
$182.98 |
| Rate for Payer: Aetna Commercial |
$164.68
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$177.49
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$141.86
|
| Rate for Payer: BCN Commercial |
$141.86
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$182.98
|
| Rate for Payer: Healthscope Whirlpool |
$177.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$164.68
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.53
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.51
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$129.92
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.02
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
OP
|
$125.73
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: Aetna Commercial |
$113.16
|
| Rate for Payer: ASR ASR |
$121.96
|
| Rate for Payer: BCBS Complete |
$50.29
|
| Rate for Payer: BCBS Trust/PPO |
$97.48
|
| Rate for Payer: BCN Commercial |
$97.48
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$118.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.58
|
| Rate for Payer: Healthscope Commercial |
$125.73
|
| Rate for Payer: Healthscope Whirlpool |
$121.96
|
| Rate for Payer: Mclaren Commercial |
$113.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.44
|
| Rate for Payer: Priority Health Narrow Network |
$13.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.64
|
|
|
HC PULSE OXIMETRY MULTI DETER
|
Facility
|
IP
|
$125.73
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.01 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: Aetna Commercial |
$113.16
|
| Rate for Payer: ASR ASR |
$121.96
|
| Rate for Payer: BCBS Trust/PPO |
$97.48
|
| Rate for Payer: BCN Commercial |
$97.48
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$118.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.58
|
| Rate for Payer: Healthscope Commercial |
$125.73
|
| Rate for Payer: Healthscope Whirlpool |
$121.96
|
| Rate for Payer: Mclaren Commercial |
$113.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.64
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
IP
|
$201.39
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$201.39 |
| Rate for Payer: Aetna Commercial |
$181.25
|
| Rate for Payer: ASR ASR |
$195.35
|
| Rate for Payer: BCBS Trust/PPO |
$156.14
|
| Rate for Payer: BCN Commercial |
$156.14
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cofinity Commercial |
$189.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.11
|
| Rate for Payer: Healthscope Commercial |
$201.39
|
| Rate for Payer: Healthscope Whirlpool |
$195.35
|
| Rate for Payer: Mclaren Commercial |
$181.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.22
|
|
|
HC PULSE OX OVERNIGHT
|
Facility
|
OP
|
$201.39
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
46000027
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$201.39 |
| Rate for Payer: Aetna Commercial |
$181.25
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$195.35
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$156.14
|
| Rate for Payer: BCN Commercial |
$156.14
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cash Price |
$161.11
|
| Rate for Payer: Cofinity Commercial |
$189.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$201.39
|
| Rate for Payer: Healthscope Whirlpool |
$195.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$181.25
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.18
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.15
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$98.52
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.22
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC PULSE OX SINGLE
|
Facility
|
OP
|
$84.74
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$84.74 |
| Rate for Payer: Aetna Commercial |
$76.27
|
| Rate for Payer: ASR ASR |
$82.20
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.70
|
| Rate for Payer: BCN Commercial |
$65.70
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$79.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$84.74
|
| Rate for Payer: Healthscope Whirlpool |
$82.20
|
| Rate for Payer: Mclaren Commercial |
$76.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Narrow Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.57
|
|
|
HC PULSE OX SINGLE
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$84.74 |
| Rate for Payer: Aetna Commercial |
$76.27
|
| Rate for Payer: ASR ASR |
$82.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.70
|
| Rate for Payer: BCN Commercial |
$65.70
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$79.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$84.74
|
| Rate for Payer: Healthscope Whirlpool |
$82.20
|
| Rate for Payer: Mclaren Commercial |
$76.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.57
|
|
|
HC PULSERIDER
|
Facility
|
OP
|
$16,734.38
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,693.75 |
| Max. Negotiated Rate |
$16,734.38 |
| Rate for Payer: Aetna Commercial |
$15,060.94
|
| Rate for Payer: ASR ASR |
$16,232.35
|
| Rate for Payer: BCBS Complete |
$6,693.75
|
| Rate for Payer: BCBS Trust/PPO |
$12,974.16
|
| Rate for Payer: BCN Commercial |
$12,974.16
|
| Rate for Payer: Cash Price |
$13,387.50
|
| Rate for Payer: Cofinity Commercial |
$15,730.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,387.50
|
| Rate for Payer: Healthscope Commercial |
$16,734.38
|
| Rate for Payer: Healthscope Whirlpool |
$16,232.35
|
| Rate for Payer: Mclaren Commercial |
$15,060.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,224.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,714.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,228.29
|
| Rate for Payer: Priority Health Narrow Network |
$11,881.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,726.25
|
|
