|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,896.50
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,824.80 |
| Max. Negotiated Rate |
$2,606.85 |
| Rate for Payer: Aetna Commercial |
$2,462.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,882.72
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,027.55
|
| Rate for Payer: Cofinity Commercial |
$2,490.99
|
| Rate for Payer: Healthscope Commercial |
$2,606.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: PHP Commercial |
$2,462.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: Priority Health SBD |
$1,824.80
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$895.52
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$805.97 |
| Rate for Payer: Aetna Commercial |
$761.19
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.09
|
| 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 |
$214.91
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$770.15
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$805.97
|
| 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 |
$761.19
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$761.19
|
| 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 |
$626.86
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$564.18
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$109.69
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$895.52
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$564.18 |
| Max. Negotiated Rate |
$805.97 |
| Rate for Payer: Aetna Commercial |
$761.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.09
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Cofinity Commercial |
$770.15
|
| Rate for Payer: Healthscope Commercial |
$805.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.19
|
| Rate for Payer: PHP Commercial |
$761.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.86
|
| Rate for Payer: Priority Health SBD |
$564.18
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,106.75
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$697.25 |
| Max. Negotiated Rate |
$996.08 |
| Rate for Payer: Aetna Commercial |
$940.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.39
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$774.72
|
| Rate for Payer: Cofinity Commercial |
$951.80
|
| Rate for Payer: Healthscope Commercial |
$996.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.74
|
| Rate for Payer: PHP Commercial |
$940.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.72
|
| Rate for Payer: Priority Health SBD |
$697.25
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,106.75
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$996.08 |
| Rate for Payer: Aetna Commercial |
$940.74
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.39
|
| 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 |
$257.88
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$951.80
|
| Rate for Payer: Cofinity Commercial |
$774.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$996.08
|
| 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 |
$940.74
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$940.74
|
| 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 |
$774.72
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$697.25
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$131.63
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,429.29
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$1,286.36 |
| Rate for Payer: Aetna Commercial |
$1,214.90
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.04
|
| 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 |
$330.03
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,000.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$1,286.36
|
| 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 |
$1,214.90
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$1,214.90
|
| 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 |
$1,000.50
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$900.45
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$171.91
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,429.29
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$900.45 |
| Max. Negotiated Rate |
$1,286.36 |
| Rate for Payer: Aetna Commercial |
$1,214.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.04
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,000.50
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,286.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,214.90
|
| Rate for Payer: PHP Commercial |
$1,214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.50
|
| Rate for Payer: Priority Health SBD |
$900.45
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,770.78
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$1,593.70 |
| Rate for Payer: Aetna Commercial |
$1,505.16
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$379.16
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,239.55
|
| Rate for Payer: Cofinity Commercial |
$1,522.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$1,593.70
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$1,505.16
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,115.59
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$207.27
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,770.78
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,115.59 |
| Max. Negotiated Rate |
$1,593.70 |
| Rate for Payer: Aetna Commercial |
$1,505.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.01
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,239.55
|
| Rate for Payer: Cofinity Commercial |
$1,522.87
|
| Rate for Payer: Healthscope Commercial |
$1,593.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: PHP Commercial |
$1,505.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: Priority Health SBD |
$1,115.59
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health SBD |
$68.04
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health SBD |
$68.04
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
IP
|
$247.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$222.89 |
| Rate for Payer: Aetna Commercial |
$210.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.98
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cofinity Commercial |
$173.36
|
| Rate for Payer: Cofinity Commercial |
$212.99
|
| Rate for Payer: Healthscope Commercial |
$222.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.51
|
| Rate for Payer: PHP Commercial |
$210.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.36
|
| Rate for Payer: Priority Health SBD |
$156.03
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$247.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$210.51
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.98
|
| 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 |
$294.73
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cofinity Commercial |
$173.36
|
| Rate for Payer: Cofinity Commercial |
$212.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$222.89
|
| 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 |
$210.51
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$210.51
|
| 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 |
$173.36
|
| 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 |
$156.03
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$81.53
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$72.45
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: BCBS Complete |
$28.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$45.64
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$72.45
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.09
|
| Rate for Payer: Cash Price |
$57.96
|
| Rate for Payer: Cofinity Commercial |
$50.72
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Healthscope Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.58
|
| Rate for Payer: PHP Commercial |
$61.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$45.64
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.91
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$61.53
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.91
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$61.53
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.91
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$61.53
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$21.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
IP
|
$228.62
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$205.76 |
| Rate for Payer: Aetna Commercial |
$194.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.60
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cofinity Commercial |
$160.03
|
| Rate for Payer: Cofinity Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$205.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.33
|
| Rate for Payer: PHP Commercial |
$194.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.03
|
| Rate for Payer: Priority Health SBD |
$144.03
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
OP
|
$228.62
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$205.76 |
| Rate for Payer: Aetna Commercial |
$194.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.60
|
| Rate for Payer: BCBS Complete |
$91.45
|
| Rate for Payer: Cash Price |
$182.90
|
| Rate for Payer: Cofinity Commercial |
$160.03
|
| Rate for Payer: Cofinity Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$205.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.33
|
| Rate for Payer: PHP Commercial |
$194.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.03
|
| Rate for Payer: Priority Health SBD |
$144.03
|
|
