|
HC EMBOLIZATION VENOUS OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37241
|
| Hospital Charge Code |
36100428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,356.27 |
| Max. Negotiated Rate |
$16,223.25 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,716.79
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$12,618.08
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health SBD |
$11,356.27
|
|
|
HC EMBOSHIELD SYSTEM
|
Facility
|
IP
|
$5,786.68
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,645.61 |
| Max. Negotiated Rate |
$5,208.01 |
| Rate for Payer: Aetna Commercial |
$4,918.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,761.34
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cofinity Commercial |
$4,050.68
|
| Rate for Payer: Cofinity Commercial |
$4,976.54
|
| Rate for Payer: Healthscope Commercial |
$5,208.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,918.68
|
| Rate for Payer: PHP Commercial |
$4,918.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.68
|
| Rate for Payer: Priority Health SBD |
$3,645.61
|
|
|
HC EMBOSHIELD SYSTEM
|
Facility
|
OP
|
$5,786.68
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,314.67 |
| Max. Negotiated Rate |
$5,208.01 |
| Rate for Payer: Aetna Commercial |
$4,918.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,761.34
|
| Rate for Payer: BCBS Complete |
$2,314.67
|
| Rate for Payer: Cash Price |
$4,629.34
|
| Rate for Payer: Cofinity Commercial |
$4,050.68
|
| Rate for Payer: Cofinity Commercial |
$4,976.54
|
| Rate for Payer: Healthscope Commercial |
$5,208.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,918.68
|
| Rate for Payer: PHP Commercial |
$4,918.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.68
|
| Rate for Payer: Priority Health SBD |
$3,645.61
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$130.53
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$110.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.84
|
| Rate for Payer: BCBS Complete |
$52.21
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Commercial |
$112.26
|
| Rate for Payer: Cofinity Commercial |
$91.37
|
| Rate for Payer: Healthscope Commercial |
$117.48
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.95
|
| Rate for Payer: PHP Commercial |
$110.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.37
|
| Rate for Payer: Priority Health SBD |
$82.23
|
|
|
HC EMCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$130.53
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$117.48 |
| Rate for Payer: Aetna Commercial |
$110.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.84
|
| Rate for Payer: Cash Price |
$104.42
|
| Rate for Payer: Cofinity Commercial |
$112.26
|
| Rate for Payer: Cofinity Commercial |
$91.37
|
| Rate for Payer: Healthscope Commercial |
$117.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.95
|
| Rate for Payer: PHP Commercial |
$110.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.37
|
| Rate for Payer: Priority Health SBD |
$82.23
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
OP
|
$344.16
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$101.33 |
| Max. Negotiated Rate |
$472.56 |
| Rate for Payer: Aetna Commercial |
$292.54
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$101.33
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cofinity Commercial |
$240.91
|
| Rate for Payer: Cofinity Commercial |
$295.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$309.74
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.54
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$292.54
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.91
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health SBD |
$216.82
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$429.60
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC EMG ANAL SPHINCTER
|
Facility
|
IP
|
$344.16
|
|
|
Service Code
|
CPT 51785
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$216.82 |
| Max. Negotiated Rate |
$309.74 |
| Rate for Payer: Aetna Commercial |
$292.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.70
|
| Rate for Payer: Cash Price |
$275.33
|
| Rate for Payer: Cofinity Commercial |
$240.91
|
| Rate for Payer: Cofinity Commercial |
$295.98
|
| Rate for Payer: Healthscope Commercial |
$309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.54
|
| Rate for Payer: PHP Commercial |
$292.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.91
|
| Rate for Payer: Priority Health SBD |
$216.82
|
|
|
HC EMG BLADDER
|
Facility
|
OP
|
$357.96
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$304.27
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cofinity Commercial |
$307.85
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$322.16
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.27
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$304.27
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$225.51
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG BLADDER
|
Facility
|
IP
|
$357.96
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$225.51 |
| Max. Negotiated Rate |
$322.16 |
| Rate for Payer: Aetna Commercial |
$304.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.67
|
| Rate for Payer: Cash Price |
$286.37
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Cofinity Commercial |
$307.85
|
| Rate for Payer: Healthscope Commercial |
$322.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.27
|
| Rate for Payer: PHP Commercial |
$304.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.57
|
| Rate for Payer: Priority Health SBD |
$225.51
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
IP
|
$241.54
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.17 |
| Max. Negotiated Rate |
$217.39 |
| Rate for Payer: Aetna Commercial |
$205.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.00
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Healthscope Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.31
|
| Rate for Payer: PHP Commercial |
$205.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.08
|
| Rate for Payer: Priority Health SBD |
$152.17
|
|
|
HC EMG BLINK REFLEX
|
Facility
|
OP
|
$241.54
|
|
|
Service Code
|
CPT 95933
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$236.41 |
| Rate for Payer: Aetna Commercial |
$205.31
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$236.41
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cash Price |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$169.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$217.39
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.31
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$205.31
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$152.17
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$80.88
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
OP
|
$600.05
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$540.04 |
| Rate for Payer: Aetna Commercial |
$510.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.03
|
| Rate for Payer: BCBS Complete |
$240.02
|
| Rate for Payer: BCBS Trust/PPO |
$216.45
|
| Rate for Payer: Cash Price |
$480.04
|
| Rate for Payer: Cash Price |
$480.04
|
| Rate for Payer: Cofinity Commercial |
$420.04
|
| Rate for Payer: Cofinity Commercial |
$516.04
|
| Rate for Payer: Healthscope Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.04
|
| Rate for Payer: PHP Commercial |
$510.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.04
|
| Rate for Payer: Priority Health SBD |
$378.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.33
|
| Rate for Payer: UHC Exchange |
$81.21
|
|
|
HC EMG CRANIAL CERV THOR LUMB PARASPINE NDL EXAM W NCS UNI
|
Facility
|
IP
|
$600.05
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
92200024
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$378.03 |
| Max. Negotiated Rate |
$540.04 |
| Rate for Payer: Aetna Commercial |
$510.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.03
|
| Rate for Payer: Cash Price |
$480.04
|
| Rate for Payer: Cofinity Commercial |
$420.04
|
| Rate for Payer: Cofinity Commercial |
$516.04
|
| Rate for Payer: Healthscope Commercial |
$540.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.04
|
| Rate for Payer: PHP Commercial |
$510.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.04
|
| Rate for Payer: Priority Health SBD |
$378.03
|
|
|
HC EMG NDL GUIDANCE NERVE DEST WITH CHEMODENERVATION
|
Facility
|
OP
|
$183.71
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
92200034
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$73.48 |
| Max. Negotiated Rate |
$267.09 |
| Rate for Payer: Aetna Commercial |
$156.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.41
|
| Rate for Payer: BCBS Complete |
$73.48
|
| Rate for Payer: BCBS Trust/PPO |
$267.09
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cofinity Commercial |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$157.99
|
| Rate for Payer: Healthscope Commercial |
$165.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.15
|
| Rate for Payer: PHP Commercial |
$156.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.60
|
| Rate for Payer: Priority Health SBD |
$115.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.13
|
| Rate for Payer: UHC Exchange |
$74.66
|
|
|
HC EMG NDL GUIDANCE NERVE DEST WITH CHEMODENERVATION
|
Facility
|
IP
|
$183.71
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
92200034
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$115.74 |
| Max. Negotiated Rate |
$165.34 |
| Rate for Payer: Aetna Commercial |
$156.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.41
|
| Rate for Payer: Cash Price |
$146.97
|
| Rate for Payer: Cofinity Commercial |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$157.99
|
| Rate for Payer: Healthscope Commercial |
$165.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.15
|
| Rate for Payer: PHP Commercial |
$156.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.60
|
| Rate for Payer: Priority Health SBD |
$115.74
|
|
|
HC EMG NEEDLE EXAM-1 EXT.
|
Facility
|
OP
|
$585.47
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$526.92 |
| Rate for Payer: Aetna Commercial |
$497.65
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$287.05
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Cofinity Commercial |
$503.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$526.92
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$497.65
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$497.65
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$368.85
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC EMG NEEDLE EXAM-1 EXT.
|
Facility
|
IP
|
$585.47
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$368.85 |
| Max. Negotiated Rate |
$526.92 |
| Rate for Payer: Aetna Commercial |
$497.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.56
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Cofinity Commercial |
$503.50
|
| Rate for Payer: Healthscope Commercial |
$526.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$497.65
|
| Rate for Payer: PHP Commercial |
$497.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.83
|
| Rate for Payer: Priority Health SBD |
$368.85
|
|
|
HC EMG NEEDLE EXAM 2 EXT
|
Facility
|
OP
|
$690.78
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
92200002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$621.70 |
| Rate for Payer: Aetna Commercial |
$587.16
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$371.49
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$552.62
|
| Rate for Payer: Cash Price |
$552.62
|
| Rate for Payer: Cofinity Commercial |
$483.55
|
| Rate for Payer: Cofinity Commercial |
$594.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$621.70
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.16
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$587.16
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$435.19
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$156.52
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC EMG NEEDLE EXAM 2 EXT
|
Facility
|
IP
|
$690.78
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
92200002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$435.19 |
| Max. Negotiated Rate |
$621.70 |
| Rate for Payer: Aetna Commercial |
$587.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.01
|
| Rate for Payer: Cash Price |
$552.62
|
| Rate for Payer: Cofinity Commercial |
$483.55
|
| Rate for Payer: Cofinity Commercial |
$594.07
|
| Rate for Payer: Healthscope Commercial |
$621.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.16
|
| Rate for Payer: PHP Commercial |
$587.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.55
|
| Rate for Payer: Priority Health SBD |
$435.19
|
|
|
HC EMG NEEDLE EXAM 3 EXT
|
Facility
|
IP
|
$638.36
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
92200003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$402.17 |
| Max. Negotiated Rate |
$574.52 |
| Rate for Payer: Aetna Commercial |
$542.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.93
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Cofinity Commercial |
$446.85
|
| Rate for Payer: Cofinity Commercial |
$548.99
|
| Rate for Payer: Healthscope Commercial |
$574.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$542.61
|
| Rate for Payer: PHP Commercial |
$542.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.85
|
| Rate for Payer: Priority Health SBD |
$402.17
|
|
|
HC EMG NEEDLE EXAM 3 EXT
|
Facility
|
OP
|
$638.36
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
92200003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$574.52 |
| Rate for Payer: Aetna Commercial |
$542.61
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$511.17
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Cofinity Commercial |
$446.85
|
| Rate for Payer: Cofinity Commercial |
$548.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$574.52
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$542.61
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$542.61
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$402.17
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$203.34
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG NEEDLE EXAM 4 EXT
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
92200004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health SBD |
$504.33
|
|
|
HC EMG NEEDLE EXAM 4 EXT
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
92200004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$597.15
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$504.33
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$227.24
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG NEEDLE EXAM CRANIAL BILAT NCS
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$135.89 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$360.74
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$504.33
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$135.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EMG NEEDLE EXAM CRANIAL BILAT NCS
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health SBD |
$504.33
|
|
