|
HC EMG NEEDLE EXAM CRANIAL UNILAT WO NCS
|
Facility
|
IP
|
$720.52
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$453.93 |
| Max. Negotiated Rate |
$648.47 |
| Rate for Payer: Aetna Commercial |
$612.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.34
|
| Rate for Payer: Cash Price |
$576.42
|
| Rate for Payer: Cofinity Commercial |
$619.65
|
| Rate for Payer: Cofinity Commercial |
$504.36
|
| Rate for Payer: Healthscope Commercial |
$648.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.44
|
| Rate for Payer: PHP Commercial |
$612.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.36
|
| Rate for Payer: Priority Health SBD |
$453.93
|
|
|
HC EMG NEEDLE EXAM CRANIAL UNILAT WO NCS
|
Facility
|
OP
|
$720.52
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$648.47 |
| Rate for Payer: Aetna Commercial |
$612.44
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.34
|
| 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 |
$303.94
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$576.42
|
| Rate for Payer: Cash Price |
$576.42
|
| Rate for Payer: Cofinity Commercial |
$504.36
|
| Rate for Payer: Cofinity Commercial |
$619.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$648.47
|
| 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 |
$612.44
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$612.44
|
| 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 |
$504.36
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$453.93
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$104.45
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EMG NEEDLE EXAM WITH NCS LIMITED
|
Facility
|
IP
|
$367.63
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
92200022
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$231.61 |
| Max. Negotiated Rate |
$330.87 |
| Rate for Payer: Aetna Commercial |
$312.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.96
|
| Rate for Payer: Cash Price |
$294.10
|
| Rate for Payer: Cofinity Commercial |
$257.34
|
| Rate for Payer: Cofinity Commercial |
$316.16
|
| Rate for Payer: Healthscope Commercial |
$330.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.49
|
| Rate for Payer: PHP Commercial |
$312.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.34
|
| Rate for Payer: Priority Health SBD |
$231.61
|
|
|
HC EMG NEEDLE EXAM WITH NCS LIMITED
|
Facility
|
OP
|
$367.63
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
92200022
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$330.87 |
| Rate for Payer: Aetna Commercial |
$312.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.96
|
| Rate for Payer: BCBS Complete |
$147.05
|
| Rate for Payer: BCBS Trust/PPO |
$202.64
|
| Rate for Payer: Cash Price |
$294.10
|
| Rate for Payer: Cash Price |
$294.10
|
| Rate for Payer: Cofinity Commercial |
$257.34
|
| Rate for Payer: Cofinity Commercial |
$316.16
|
| Rate for Payer: Healthscope Commercial |
$330.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.49
|
| Rate for Payer: PHP Commercial |
$312.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.34
|
| Rate for Payer: Priority Health SBD |
$231.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.64
|
| Rate for Payer: UHC Exchange |
$60.58
|
|
|
HC EMG NEEDLE EXAM WITH NCV COMPLETE
|
Facility
|
OP
|
$445.19
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
92200023
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$400.67 |
| Rate for Payer: Aetna Commercial |
$378.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.37
|
| Rate for Payer: BCBS Complete |
$178.08
|
| Rate for Payer: BCBS Trust/PPO |
$242.54
|
| Rate for Payer: Cash Price |
$356.15
|
| Rate for Payer: Cash Price |
$356.15
|
| Rate for Payer: Cofinity Commercial |
$311.63
|
| Rate for Payer: Cofinity Commercial |
$382.86
|
| Rate for Payer: Healthscope Commercial |
$400.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$378.41
|
| Rate for Payer: PHP Commercial |
$378.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.63
|
| Rate for Payer: Priority Health SBD |
$280.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Exchange |
$94.30
|
|
|
HC EMG NEEDLE EXAM WITH NCV COMPLETE
|
Facility
|
IP
|
$445.19
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
92200023
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$280.47 |
| Max. Negotiated Rate |
$400.67 |
| Rate for Payer: Aetna Commercial |
$378.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.37
|
| Rate for Payer: Cash Price |
$356.15
|
| Rate for Payer: Cofinity Commercial |
$311.63
|
| Rate for Payer: Cofinity Commercial |
$382.86
|
| Rate for Payer: Healthscope Commercial |
$400.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$378.41
|
| Rate for Payer: PHP Commercial |
$378.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.63
|
| Rate for Payer: Priority Health SBD |
$280.47
|
|
|
HC EMG NEEDLE FROM LARYNX
|
Facility
|
OP
|
$390.33
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$351.30 |
| Rate for Payer: Aetna Commercial |
$331.78
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.71
|
| 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 |
$316.23
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$312.26
|
| Rate for Payer: Cash Price |
$312.26
|
| Rate for Payer: Cofinity Commercial |
$335.68
|
| Rate for Payer: Cofinity Commercial |
$273.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$351.30
|
| 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 |
$331.78
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$331.78
|
| 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 |
$273.23
|
| 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 |
$245.91
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$146.04
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC EMG NEEDLE FROM LARYNX
|
Facility
|
IP
|
$390.33
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$245.91 |
| Max. Negotiated Rate |
$351.30 |
| Rate for Payer: Aetna Commercial |
$331.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.71
|
| Rate for Payer: Cash Price |
$312.26
|
| Rate for Payer: Cofinity Commercial |
$273.23
|
| Rate for Payer: Cofinity Commercial |
$335.68
|
| Rate for Payer: Healthscope Commercial |
$351.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.78
|
| Rate for Payer: PHP Commercial |
$331.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.23
|
| Rate for Payer: Priority Health SBD |
$245.91
|
|
|
HC EMG REPETITIVE STIMULATION
|
Facility
|
OP
|
$430.40
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
92200021
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$365.84
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.76
|
| 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 |
$328.52
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$344.32
|
| Rate for Payer: Cash Price |
$344.32
|
| Rate for Payer: Cofinity Commercial |
$301.28
|
| Rate for Payer: Cofinity Commercial |
$370.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$387.36
|
| 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 |
$365.84
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$365.84
|
| 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 |
$301.28
|
| 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 |
$271.15
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$102.16
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG REPETITIVE STIMULATION
|
Facility
|
IP
|
$430.40
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
92200021
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$387.36 |
| Rate for Payer: Aetna Commercial |
$365.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.76
|
| Rate for Payer: Cash Price |
$344.32
|
| Rate for Payer: Cofinity Commercial |
$370.14
|
| Rate for Payer: Cofinity Commercial |
$301.28
|
| Rate for Payer: Healthscope Commercial |
$387.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.84
|
| Rate for Payer: PHP Commercial |
$365.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.28
|
| Rate for Payer: Priority Health SBD |
$271.15
|
|
|
HC EMG SINGLE FIBER
|
Facility
|
IP
|
$450.54
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
92200010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$283.84 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health SBD |
$283.84
|
|
|
HC EMG SINGLE FIBER
|
Facility
|
OP
|
$450.54
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
92200010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| 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 |
$228.74
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| 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 |
$382.96
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$382.96
|
| 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 |
$315.38
|
| 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 |
$283.84
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$184.35
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG SURFACE FROM LARYNX
|
Facility
|
IP
|
$272.42
|
|
|
Service Code
|
CPT 95999
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$171.62 |
| Max. Negotiated Rate |
$245.18 |
| Rate for Payer: Aetna Commercial |
$231.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.07
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Cofinity Commercial |
$234.28
|
| Rate for Payer: Cofinity Commercial |
$190.69
|
| Rate for Payer: Healthscope Commercial |
$245.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.56
|
| Rate for Payer: PHP Commercial |
$231.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.69
|
| Rate for Payer: Priority Health SBD |
$171.62
|
|
|
HC EMG SURFACE FROM LARYNX
|
Facility
|
OP
|
$272.42
|
|
|
Service Code
|
CPT 95999
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$231.56
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.07
|
| 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 |
$422.58
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Cash Price |
$217.94
|
| Rate for Payer: Cofinity Commercial |
$190.69
|
| Rate for Payer: Cofinity Commercial |
$234.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$245.18
|
| 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 |
$231.56
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$231.56
|
| 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 |
$190.69
|
| 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 |
$171.62
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC EMG THORACIC PSP. NEEDLE EXAM
|
Facility
|
OP
|
$514.90
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$93.32 |
| Max. Negotiated Rate |
$463.41 |
| Rate for Payer: Aetna Commercial |
$437.66
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.68
|
| 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 |
$351.53
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$411.92
|
| Rate for Payer: Cash Price |
$411.92
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$360.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$463.41
|
| 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 |
$437.66
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$437.66
|
| 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 |
$360.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$324.39
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$93.32
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EMG THORACIC PSP. NEEDLE EXAM
|
Facility
|
IP
|
$514.90
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$324.39 |
| Max. Negotiated Rate |
$463.41 |
| Rate for Payer: Aetna Commercial |
$437.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.68
|
| Rate for Payer: Cash Price |
$411.92
|
| Rate for Payer: Cofinity Commercial |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Healthscope Commercial |
$463.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.66
|
| Rate for Payer: PHP Commercial |
$437.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.43
|
| Rate for Payer: Priority Health SBD |
$324.39
|
|
|
HC EMR RENAL BIOPSY (BILL ONLY)
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
31200008
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$197.23 |
| Max. Negotiated Rate |
$2,040.47 |
| Rate for Payer: Aetna Commercial |
$487.05
|
| Rate for Payer: Aetna Medicare |
$795.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$956.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$956.40
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS MAPPO |
$765.12
|
| Rate for Payer: BCBS Trust/PPO |
$490.64
|
| Rate for Payer: BCN Medicare Advantage |
$765.12
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Cofinity Commercial |
$492.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.12
|
| Rate for Payer: Healthscope Commercial |
$515.70
|
| Rate for Payer: Mclaren Medicaid |
$418.52
|
| Rate for Payer: Mclaren Medicare |
$765.12
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$803.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$879.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.05
|
| Rate for Payer: PACE Medicare |
$726.86
|
| Rate for Payer: PACE SWMI |
$765.12
|
| Rate for Payer: PHP Commercial |
$487.05
|
| Rate for Payer: PHP Medicare Advantage |
$765.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,040.47
|
| Rate for Payer: Priority Health Medicare |
$765.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,632.38
|
| Rate for Payer: Priority Health SBD |
$360.99
|
| Rate for Payer: Railroad Medicare Medicare |
$765.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.35
|
| Rate for Payer: UHC Core |
$197.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.12
|
| Rate for Payer: UHC Exchange |
$475.77
|
| Rate for Payer: UHC Medicare Advantage |
$788.07
|
| Rate for Payer: VA VA |
$765.12
|
|
|
HC EMR RENAL BIOPSY (BILL ONLY)
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
31200008
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$360.99 |
| Max. Negotiated Rate |
$515.70 |
| Rate for Payer: Aetna Commercial |
$487.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.45
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Cofinity Commercial |
$492.78
|
| Rate for Payer: Healthscope Commercial |
$515.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.05
|
| Rate for Payer: PHP Commercial |
$487.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.10
|
| Rate for Payer: Priority Health SBD |
$360.99
|
|
|
HC ENA EXTRACTABLE NUCLEAR AB PANEL
|
Facility
|
IP
|
$32.45
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$29.20 |
| Rate for Payer: Aetna Commercial |
$27.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.09
|
| Rate for Payer: Cash Price |
$25.96
|
| Rate for Payer: Cofinity Commercial |
$27.91
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Healthscope Commercial |
$29.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.58
|
| Rate for Payer: PHP Commercial |
$27.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.72
|
| Rate for Payer: Priority Health SBD |
$20.44
|
|
|
HC ENA EXTRACTABLE NUCLEAR AB PANEL
|
Facility
|
OP
|
$32.45
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200170
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$30.48 |
| Rate for Payer: Aetna Commercial |
$27.58
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.96
|
| Rate for Payer: Cash Price |
$25.96
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Cofinity Commercial |
$27.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$29.20
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.58
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.58
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.72
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.44
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC ENA EXTRACTABLE NUCLEAR AB SCREEN
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200169
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC ENA EXTRACTABLE NUCLEAR AB SCREEN
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200169
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC ENCEPHALOPATHY EVAL, CSF
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna Commercial |
$128.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.15
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$129.86
|
| Rate for Payer: Cofinity Commercial |
$105.70
|
| Rate for Payer: Healthscope Commercial |
$135.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.35
|
| Rate for Payer: PHP Commercial |
$128.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
| Rate for Payer: Priority Health SBD |
$95.13
|
|
|
HC ENCEPHALOPATHY EVAL, CSF
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna Commercial |
$128.35
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$105.70
|
| Rate for Payer: Cofinity Commercial |
$129.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$135.90
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.35
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$128.35
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$95.13
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ENCEPHALOPATHY EVAL, CSF CMPT 1
|
Facility
|
IP
|
$65.71
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$59.14 |
| Rate for Payer: Aetna Commercial |
$55.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.71
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cofinity Commercial |
$46.00
|
| Rate for Payer: Cofinity Commercial |
$56.51
|
| Rate for Payer: Healthscope Commercial |
$59.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.85
|
| Rate for Payer: PHP Commercial |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.00
|
| Rate for Payer: Priority Health SBD |
$41.40
|
|
