|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: Aetna Medicare |
$17,512.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCBS Trust/PPO |
$23,877.98
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,512.83
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$19,264.11
|
| Rate for Payer: PHP Medicaid |
$9,386.88
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,548.77
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health Narrow Network |
$20,440.18
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Exchange |
$27,144.89
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP DNSP |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,386.88
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,953.09 |
| Max. Negotiated Rate |
$29,158.60 |
| Rate for Payer: Aetna Commercial |
$26,242.74
|
| Rate for Payer: ASR ASR |
$28,283.84
|
| Rate for Payer: ASR Commercial |
$28,283.84
|
| Rate for Payer: BCBS Trust/PPO |
$23,761.34
|
| Rate for Payer: BCN Commercial |
$22,606.66
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$27,409.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$29,158.60
|
| Rate for Payer: Healthscope Whirlpool |
$28,283.84
|
| Rate for Payer: Mclaren Commercial |
$26,242.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25,659.57
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna Commercial |
$283.25
|
| Rate for Payer: Aetna Medicare |
$157.36
|
| Rate for Payer: ASR ASR |
$305.28
|
| Rate for Payer: ASR Commercial |
$305.28
|
| Rate for Payer: BCBS Complete |
$125.89
|
| Rate for Payer: BCBS Trust/PPO |
$257.72
|
| Rate for Payer: BCN Commercial |
$244.00
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$314.72
|
| Rate for Payer: Healthscope Whirlpool |
$305.28
|
| Rate for Payer: Mclaren Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.76
|
| Rate for Payer: Priority Health Narrow Network |
$220.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.95
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$204.57 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna Commercial |
$283.25
|
| Rate for Payer: ASR ASR |
$305.28
|
| Rate for Payer: ASR Commercial |
$305.28
|
| Rate for Payer: BCBS Trust/PPO |
$256.47
|
| Rate for Payer: BCN Commercial |
$244.00
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$314.72
|
| Rate for Payer: Healthscope Whirlpool |
$305.28
|
| Rate for Payer: Mclaren Commercial |
$283.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.95
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$128.75
|
| Rate for Payer: ASR ASR |
$249.78
|
| Rate for Payer: ASR Commercial |
$249.78
|
| Rate for Payer: BCBS Complete |
$103.00
|
| Rate for Payer: BCBS Trust/PPO |
$210.87
|
| Rate for Payer: BCN Commercial |
$199.64
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$242.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Healthscope Whirlpool |
$249.78
|
| Rate for Payer: Mclaren Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.62
|
| Rate for Payer: Priority Health Narrow Network |
$180.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.60
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: ASR ASR |
$249.78
|
| Rate for Payer: ASR Commercial |
$249.78
|
| Rate for Payer: BCBS Trust/PPO |
$209.84
|
| Rate for Payer: BCN Commercial |
$199.64
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$242.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Healthscope Whirlpool |
$249.78
|
| Rate for Payer: Mclaren Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.60
|
|
|
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 |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Trust/PPO |
$233.15
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: ASR ASR |
$277.53
|
| Rate for Payer: ASR Commercial |
$277.53
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$221.82
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$286.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.53
|
| Rate for Payer: Mclaren Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.78
|
|
|
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 |
$70.44 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: ASR ASR |
$68.33
|
| Rate for Payer: ASR Commercial |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$57.40
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$68.33
|
| Rate for Payer: Mclaren Commercial |
$63.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.99
|
|
|
HC PT MIX 1:1
|
Facility
|
OP
|
$70.44
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
30500107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$70.44 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| 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 |
$68.33
|
| Rate for Payer: ASR Commercial |
$68.33
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$57.68
|
| Rate for Payer: BCN Commercial |
$54.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$68.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$63.40
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Medicaid |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.87
|
| Rate for Payer: Nomi Health Commercial |
$57.76
|
| 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 |
$2.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$6.11
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHCCP DNSP |
$3.94
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: VA VA |
$3.94
|
|
|
HC PT NEUROSTIM
|
Facility
|
OP
|
$97.14
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$97.14 |
| Rate for Payer: Aetna Commercial |
$87.43
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: ASR ASR |
$94.23
|
| Rate for Payer: ASR Commercial |
$94.23
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS Trust/PPO |
$79.55
|
| Rate for Payer: BCN Commercial |
$75.31
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Healthscope Whirlpool |
$94.23
|
| Rate for Payer: Mclaren Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.11
|
| Rate for Payer: Priority Health Narrow Network |
$68.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.48
|
|
|
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 |
$97.14 |
| Rate for Payer: Aetna Commercial |
$87.43
|
| Rate for Payer: ASR ASR |
$94.23
|
| Rate for Payer: ASR Commercial |
$94.23
|
| Rate for Payer: BCBS Trust/PPO |
$79.16
|
| Rate for Payer: BCN Commercial |
$75.31
|
| Rate for Payer: Cash Price |
$77.71
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.71
|
| Rate for Payer: Healthscope Commercial |
$97.14
|
| Rate for Payer: Healthscope Whirlpool |
$94.23
|
| Rate for Payer: Mclaren Commercial |
$87.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.57
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.48
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$128.16
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
42400009
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: ASR Commercial |
$124.32
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Trust/PPO |
$104.95
|
| Rate for Payer: BCN Commercial |
$99.36
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$128.16
|
| Rate for Payer: Healthscope Whirlpool |
$124.32
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$89.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
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 |
$128.16 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: ASR ASR |
$124.32
|
| Rate for Payer: ASR Commercial |
$124.32
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$99.36
|
| Rate for Payer: Cash Price |
$102.53
|
| Rate for Payer: Cofinity Commercial |
$120.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$128.16
|
| Rate for Payer: Healthscope Whirlpool |
$124.32
|
| Rate for Payer: Mclaren Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.94
|
| Rate for Payer: Nomi Health Commercial |
$105.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.78
|
|
|
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 |
$12.80 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: ASR Commercial |
$85.05
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: BCN Commercial |
$67.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$87.68
|
| Rate for Payer: Healthscope Whirlpool |
$85.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.83
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$61.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
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 |
$87.68 |
| Rate for Payer: Aetna Commercial |
$78.91
|
| Rate for Payer: ASR ASR |
$85.05
|
| Rate for Payer: ASR Commercial |
$85.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.45
|
| Rate for Payer: BCN Commercial |
$67.98
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$82.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$87.68
|
| Rate for Payer: Healthscope Whirlpool |
$85.05
|
| Rate for Payer: Mclaren Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.16
|
|
|
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 |
$1,701.19 |
| Rate for Payer: Aetna Commercial |
$1,531.07
|
| Rate for Payer: ASR ASR |
$1,650.15
|
| Rate for Payer: ASR Commercial |
$1,650.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,386.30
|
| Rate for Payer: BCN Commercial |
$1,318.93
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,599.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Healthscope Commercial |
$1,701.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.15
|
| Rate for Payer: Mclaren Commercial |
$1,531.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: Nomi Health Commercial |
$1,394.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,497.05
|
|
|
HC PULMONARY ARTERIOGRAM NONSELECTIVE
|
Facility
|
OP
|
$1,701.19
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
32000197
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,105.77 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$1,531.07
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$1,650.15
|
| Rate for Payer: ASR Commercial |
$1,650.15
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.10
|
| Rate for Payer: BCN Commercial |
$1,318.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cash Price |
$1,360.95
|
| Rate for Payer: Cofinity Commercial |
$1,599.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$1,701.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$1,531.07
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,446.01
|
| Rate for Payer: Nomi Health Commercial |
$1,394.98
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,490.58
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.53
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,497.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC PULMONARY EXERCISE GROUP
|
Facility
|
OP
|
$105.20
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000044
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$105.20 |
| Rate for Payer: Aetna Commercial |
$94.68
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$102.04
|
| Rate for Payer: ASR Commercial |
$102.04
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$86.15
|
| Rate for Payer: BCN Commercial |
$81.56
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$98.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$105.20
|
| Rate for Payer: Healthscope Whirlpool |
$102.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$94.68
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: Nomi Health Commercial |
$86.26
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.18
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$73.75
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
|
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 |
$105.20 |
| Rate for Payer: Aetna Commercial |
$94.68
|
| Rate for Payer: ASR ASR |
$102.04
|
| Rate for Payer: ASR Commercial |
$102.04
|
| Rate for Payer: BCBS Trust/PPO |
$85.73
|
| Rate for Payer: BCN Commercial |
$81.56
|
| Rate for Payer: Cash Price |
$84.16
|
| Rate for Payer: Cofinity Commercial |
$98.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.16
|
| Rate for Payer: Healthscope Commercial |
$105.20
|
| Rate for Payer: Healthscope Whirlpool |
$102.04
|
| Rate for Payer: Mclaren Commercial |
$94.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.42
|
| Rate for Payer: Nomi Health Commercial |
$86.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.58
|
|
|
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 |
$371.82 |
| Rate for Payer: Aetna Commercial |
$334.64
|
| Rate for Payer: ASR ASR |
$360.67
|
| Rate for Payer: ASR Commercial |
$360.67
|
| Rate for Payer: BCBS Trust/PPO |
$303.00
|
| Rate for Payer: BCN Commercial |
$288.27
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$349.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Healthscope Commercial |
$371.82
|
| Rate for Payer: Healthscope Whirlpool |
$360.67
|
| Rate for Payer: Mclaren Commercial |
$334.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: Nomi Health Commercial |
$304.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.20
|
|
|
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 |
$67.38 |
| Max. Negotiated Rate |
$371.82 |
| Rate for Payer: Aetna Commercial |
$334.64
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$360.67
|
| Rate for Payer: ASR Commercial |
$360.67
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$304.48
|
| Rate for Payer: BCN Commercial |
$288.27
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cash Price |
$297.46
|
| Rate for Payer: Cofinity Commercial |
$349.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$371.82
|
| Rate for Payer: Healthscope Whirlpool |
$360.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$334.64
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.05
|
| Rate for Payer: Nomi Health Commercial |
$304.89
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.79
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$260.65
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
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 |
$219.58 |
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: ASR ASR |
$212.99
|
| Rate for Payer: ASR Commercial |
$212.99
|
| Rate for Payer: BCBS Trust/PPO |
$178.94
|
| Rate for Payer: BCN Commercial |
$170.24
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$206.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: Healthscope Whirlpool |
$212.99
|
| Rate for Payer: Mclaren Commercial |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: Nomi Health Commercial |
$180.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.23
|
|
|
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 |
$31.05 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$212.99
|
| Rate for Payer: ASR Commercial |
$212.99
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$179.81
|
| Rate for Payer: BCN Commercial |
$170.24
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cash Price |
$175.66
|
| Rate for Payer: Cofinity Commercial |
$206.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: Healthscope Whirlpool |
$212.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$197.62
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.64
|
| Rate for Payer: Nomi Health Commercial |
$180.06
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.40
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$153.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
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 |
$186.64 |
| Rate for Payer: Aetna Commercial |
$167.98
|
| Rate for Payer: ASR ASR |
$181.04
|
| Rate for Payer: ASR Commercial |
$181.04
|
| Rate for Payer: BCBS Trust/PPO |
$152.09
|
| Rate for Payer: BCN Commercial |
$144.70
|
| Rate for Payer: Cash Price |
$149.31
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.31
|
| Rate for Payer: Healthscope Commercial |
$186.64
|
| Rate for Payer: Healthscope Whirlpool |
$181.04
|
| Rate for Payer: Mclaren Commercial |
$167.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.64
|
| Rate for Payer: Nomi Health Commercial |
$153.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.24
|
|
