|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,045.00 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,915.00
|
| Rate for Payer: ASR ASR |
$4,219.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.56
|
| Rate for Payer: BCN Commercial |
$3,372.56
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$4,089.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.00
|
| Rate for Payer: Healthscope Commercial |
$4,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,219.50
|
| Rate for Payer: Mclaren Commercial |
$3,915.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,828.00
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.24 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,915.00
|
| Rate for Payer: Aetna Medicare |
$1,508.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: ASR ASR |
$4,219.50
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.56
|
| Rate for Payer: BCN Commercial |
$3,372.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$4,089.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Healthscope Commercial |
$4,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,219.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,508.66
|
| Rate for Payer: Mclaren Commercial |
$3,915.00
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Commercial |
$1,659.53
|
| Rate for Payer: PHP Medicaid |
$825.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,958.50
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,088.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,828.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.62 |
| Max. Negotiated Rate |
$250.88 |
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: ASR ASR |
$243.35
|
| Rate for Payer: BCBS Trust/PPO |
$194.51
|
| Rate for Payer: BCN Commercial |
$194.51
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$235.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.70
|
| Rate for Payer: Healthscope Commercial |
$250.88
|
| Rate for Payer: Healthscope Whirlpool |
$243.35
|
| Rate for Payer: Mclaren Commercial |
$225.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.77
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$250.88 |
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: Aetna Medicare |
$176.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.09
|
| Rate for Payer: ASR ASR |
$243.35
|
| Rate for Payer: BCBS Complete |
$101.13
|
| Rate for Payer: BCBS MAPPO |
$176.07
|
| Rate for Payer: BCBS Trust/PPO |
$194.51
|
| Rate for Payer: BCN Commercial |
$194.51
|
| Rate for Payer: BCN Medicare Advantage |
$176.07
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$235.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.07
|
| Rate for Payer: Healthscope Commercial |
$250.88
|
| Rate for Payer: Healthscope Whirlpool |
$243.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.07
|
| Rate for Payer: Mclaren Commercial |
$225.79
|
| Rate for Payer: Mclaren Medicaid |
$96.31
|
| Rate for Payer: Mclaren Medicare |
$176.07
|
| Rate for Payer: Meridian Medicaid |
$101.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PACE Medicare |
$167.27
|
| Rate for Payer: PACE SWMI |
$176.07
|
| Rate for Payer: PHP Commercial |
$193.68
|
| Rate for Payer: PHP Medicaid |
$96.31
|
| Rate for Payer: PHP Medicare Advantage |
$176.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.30
|
| Rate for Payer: Priority Health Medicare |
$176.07
|
| Rate for Payer: Priority Health Narrow Network |
$178.12
|
| Rate for Payer: Railroad Medicare Medicare |
$176.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.77
|
| Rate for Payer: UHC Medicare Advantage |
$181.35
|
| Rate for Payer: VA VA |
$176.07
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$170.58 |
| Max. Negotiated Rate |
$243.69 |
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: ASR ASR |
$236.38
|
| Rate for Payer: BCBS Trust/PPO |
$188.93
|
| Rate for Payer: BCN Commercial |
$188.93
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$229.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.95
|
| Rate for Payer: Healthscope Commercial |
$243.69
|
| Rate for Payer: Healthscope Whirlpool |
$236.38
|
| Rate for Payer: Mclaren Commercial |
$219.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.45
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$243.69 |
| Rate for Payer: Aetna Commercial |
$219.32
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: ASR ASR |
$236.38
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$188.93
|
| Rate for Payer: BCN Commercial |
$188.93
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$229.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$243.69
|
| Rate for Payer: Healthscope Whirlpool |
$236.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.59
|
| Rate for Payer: Mclaren Commercial |
$219.32
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicaid |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.73
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.45
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: VA VA |
$189.59
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,562.72 |
| Max. Negotiated Rate |
$2,232.45 |
| Rate for Payer: Aetna Commercial |
$2,009.20
|
| Rate for Payer: ASR ASR |
$2,165.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,730.82
|
| Rate for Payer: BCN Commercial |
$1,730.82
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$2,098.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,785.96
|
| Rate for Payer: Healthscope Commercial |
$2,232.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,165.48
|
| Rate for Payer: Mclaren Commercial |
$2,009.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,964.56
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$2,232.45 |
| Rate for Payer: Aetna Commercial |
$2,009.20
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$2,165.48
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,730.82
|
| Rate for Payer: BCN Commercial |
$1,730.82
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$2,098.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,785.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$2,232.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,165.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$2,009.20
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.42
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,964.56
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$339.26 |
| Max. Negotiated Rate |
$484.65 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: ASR ASR |
$470.11
|
| Rate for Payer: BCBS Trust/PPO |
$375.75
|
| Rate for Payer: BCN Commercial |
$375.75
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$455.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.72
|
| Rate for Payer: Healthscope Commercial |
$484.65
|
| Rate for Payer: Healthscope Whirlpool |
$470.11
|
| Rate for Payer: Mclaren Commercial |
$436.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.49
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$484.65 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$470.11
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$375.75
|
| Rate for Payer: BCN Commercial |
$375.75
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$455.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$484.65
|
| Rate for Payer: Healthscope Whirlpool |
$470.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$436.18
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.13
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.49
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,896.50
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$2,896.50 |
| Rate for Payer: Aetna Commercial |
$2,606.85
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$2,809.60
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,245.66
|
| Rate for Payer: BCN Commercial |
$2,245.66
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,722.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,317.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$2,896.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,809.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$2,606.85
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.42
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,548.92
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
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 |
$2,027.55 |
| Max. Negotiated Rate |
$2,896.50 |
| Rate for Payer: Aetna Commercial |
$2,606.85
|
| Rate for Payer: ASR ASR |
$2,809.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,245.66
|
| Rate for Payer: BCN Commercial |
$2,245.66
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,722.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,317.20
|
| Rate for Payer: Healthscope Commercial |
$2,896.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,809.60
|
| Rate for Payer: Mclaren Commercial |
$2,606.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,548.92
|
|
|
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 |
$626.86 |
| Max. Negotiated Rate |
$895.52 |
| Rate for Payer: Aetna Commercial |
$805.97
|
| Rate for Payer: ASR ASR |
$868.65
|
| Rate for Payer: BCBS Trust/PPO |
$694.30
|
| Rate for Payer: BCN Commercial |
$694.30
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$841.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.42
|
| Rate for Payer: Healthscope Commercial |
$895.52
|
| Rate for Payer: Healthscope Whirlpool |
$868.65
|
| Rate for Payer: Mclaren Commercial |
$805.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$788.06
|
|
|
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 |
$36.90 |
| Max. Negotiated Rate |
$895.52 |
| Rate for Payer: Aetna Commercial |
$805.97
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$868.65
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$694.30
|
| Rate for Payer: BCN Commercial |
$694.30
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cash Price |
$716.42
|
| Rate for Payer: Cofinity Commercial |
$841.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$895.52
|
| Rate for Payer: Healthscope Whirlpool |
$868.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$805.97
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$761.19
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.13
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$788.06
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
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 |
$774.72 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Aetna Commercial |
$996.08
|
| Rate for Payer: ASR ASR |
$1,073.55
|
| Rate for Payer: BCBS Trust/PPO |
$858.06
|
| Rate for Payer: BCN Commercial |
$858.06
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$1,040.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.40
|
| Rate for Payer: Healthscope Commercial |
$1,106.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.55
|
| Rate for Payer: Mclaren Commercial |
$996.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$973.94
|
|
|
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 |
$36.90 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Aetna Commercial |
$996.08
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$1,073.55
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$858.06
|
| Rate for Payer: BCN Commercial |
$858.06
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cash Price |
$885.40
|
| Rate for Payer: Cofinity Commercial |
$1,040.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$1,106.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$996.08
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.74
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.13
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$973.94
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
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 |
$1,000.50 |
| Max. Negotiated Rate |
$1,429.29 |
| Rate for Payer: Aetna Commercial |
$1,286.36
|
| Rate for Payer: ASR ASR |
$1,386.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.13
|
| Rate for Payer: BCN Commercial |
$1,108.13
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,343.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.43
|
| Rate for Payer: Healthscope Commercial |
$1,429.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.41
|
| Rate for Payer: Mclaren Commercial |
$1,286.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.78
|
|
|
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 |
$36.90 |
| Max. Negotiated Rate |
$1,429.29 |
| Rate for Payer: Aetna Commercial |
$1,286.36
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$1,386.41
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.13
|
| Rate for Payer: BCN Commercial |
$1,108.13
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cash Price |
$1,143.43
|
| Rate for Payer: Cofinity Commercial |
$1,343.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$1,429.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$1,286.36
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,214.90
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.13
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.78
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
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 |
$1,239.55 |
| Max. Negotiated Rate |
$1,770.78 |
| Rate for Payer: Aetna Commercial |
$1,593.70
|
| Rate for Payer: ASR ASR |
$1,717.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.89
|
| Rate for Payer: BCN Commercial |
$1,372.89
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,664.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.62
|
| Rate for Payer: Healthscope Commercial |
$1,770.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,717.66
|
| Rate for Payer: Mclaren Commercial |
$1,593.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,558.29
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$1,770.78 |
| Rate for Payer: Aetna Commercial |
$1,593.70
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$1,717.66
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.89
|
| Rate for Payer: BCN Commercial |
$1,372.89
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cash Price |
$1,416.62
|
| Rate for Payer: Cofinity Commercial |
$1,664.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,770.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,717.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$1,593.70
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,505.16
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.42
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,558.29
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: ASR ASR |
$104.76
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$101.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Healthscope Whirlpool |
$104.76
|
| Rate for Payer: Mclaren Commercial |
$97.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.04
|
|
|
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 |
$108.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: ASR ASR |
$104.76
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$101.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$108.00
|
| Rate for Payer: Healthscope Whirlpool |
$104.76
|
| Rate for Payer: Mclaren Commercial |
$97.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.28
|
| Rate for Payer: Priority Health Narrow Network |
$76.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.04
|
|
|
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 |
$173.36 |
| Max. Negotiated Rate |
$247.66 |
| Rate for Payer: Aetna Commercial |
$222.89
|
| Rate for Payer: ASR ASR |
$240.23
|
| Rate for Payer: BCBS Trust/PPO |
$192.01
|
| Rate for Payer: BCN Commercial |
$192.01
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cofinity Commercial |
$232.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.13
|
| Rate for Payer: Healthscope Commercial |
$247.66
|
| Rate for Payer: Healthscope Whirlpool |
$240.23
|
| Rate for Payer: Mclaren Commercial |
$222.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.94
|
|
