|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$311.43 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.32
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$346.04
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health SBD |
$311.43
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Cofinity Commercial |
$346.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$311.43
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$365.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$365.81
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,861.29 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.38
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,068.10
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,068.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health SBD |
$1,861.29
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Cofinity Commercial |
$2,068.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,068.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,861.29
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$2,186.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$2,186.28
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$575.46 |
| Max. Negotiated Rate |
$822.09 |
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.73
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$639.40
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health SBD |
$575.46
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Commercial |
$639.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$575.46
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$675.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$675.94
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,128.89
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$711.20 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$959.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.78
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$790.22
|
| Rate for Payer: Cofinity Commercial |
$970.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Healthscope Commercial |
$1,016.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health SBD |
$711.20
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,128.89
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$959.56
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$970.85
|
| Rate for Payer: Cofinity Commercial |
$790.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,016.00
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$711.20
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$835.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$835.38
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,457.88
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$918.46 |
| Max. Negotiated Rate |
$1,312.09 |
| Rate for Payer: Aetna Commercial |
$1,239.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.62
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cofinity Commercial |
$1,020.52
|
| Rate for Payer: Cofinity Commercial |
$1,253.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.30
|
| Rate for Payer: Healthscope Commercial |
$1,312.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.20
|
| Rate for Payer: PHP Commercial |
$1,239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.62
|
| Rate for Payer: Priority Health SBD |
$918.46
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,457.88
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,312.09 |
| Rate for Payer: Aetna Commercial |
$1,239.20
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cofinity Commercial |
$1,253.78
|
| Rate for Payer: Cofinity Commercial |
$1,020.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,312.09
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.20
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$1,239.20
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.62
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$918.46
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$1,078.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$1,078.83
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,806.20
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,137.91 |
| Max. Negotiated Rate |
$1,625.58 |
| Rate for Payer: Aetna Commercial |
$1,535.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cofinity Commercial |
$1,264.34
|
| Rate for Payer: Cofinity Commercial |
$1,553.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,264.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,444.96
|
| Rate for Payer: Healthscope Commercial |
$1,625.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,535.27
|
| Rate for Payer: PHP Commercial |
$1,535.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.03
|
| Rate for Payer: Priority Health SBD |
$1,137.91
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,806.20
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,625.58 |
| Rate for Payer: Aetna Commercial |
$1,535.27
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,174.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cofinity Commercial |
$1,553.33
|
| Rate for Payer: Cofinity Commercial |
$1,264.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,264.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,444.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,625.58
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,535.27
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,535.27
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.03
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,137.91
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$1,336.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$1,336.59
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$110.16
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: Priority Health SBD |
$69.40
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$110.16
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: Priority Health SBD |
$69.40
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
IP
|
$252.61
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$159.14 |
| Max. Negotiated Rate |
$227.35 |
| Rate for Payer: Aetna Commercial |
$214.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.20
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cofinity Commercial |
$176.83
|
| Rate for Payer: Cofinity Commercial |
$217.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.09
|
| Rate for Payer: Healthscope Commercial |
$227.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.72
|
| Rate for Payer: PHP Commercial |
$214.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.20
|
| Rate for Payer: Priority Health SBD |
$159.14
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$252.61
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$214.72
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cofinity Commercial |
$217.24
|
| Rate for Payer: Cofinity Commercial |
$176.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$227.35
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.72
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$214.72
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.20
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$159.14
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$186.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$186.93
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$73.90
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna Commercial |
$62.81
|
| Rate for Payer: Aetna Medicare |
$36.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.03
|
| Rate for Payer: BCBS Complete |
$29.56
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cofinity Commercial |
$51.73
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$66.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.81
|
| Rate for Payer: PHP Commercial |
$62.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.03
|
| Rate for Payer: Priority Health SBD |
$46.56
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$73.90
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna Commercial |
$62.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.03
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cofinity Commercial |
$51.73
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$66.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.81
|
| Rate for Payer: PHP Commercial |
$62.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.03
|
| Rate for Payer: Priority Health SBD |
$46.56
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| 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: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| 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: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
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: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.49
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
