|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,728.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12,546.00 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$15,055.20
|
| Rate for Payer: ASR ASR |
$16,226.16
|
| Rate for Payer: BCBS Trust/PPO |
$13,737.03
|
| Rate for Payer: BCN Commercial |
$13,737.03
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Commercial |
$15,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Healthscope Commercial |
$16,226.16
|
| Rate for Payer: Healthscope Whirlpool |
$16,728.00
|
| Rate for Payer: Mclaren Commercial |
$15,055.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$13,716.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,720.64
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,728.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$15,055.20
|
| Rate for Payer: Aetna Medicare |
$5,898.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: ASR ASR |
$16,226.16
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$13,792.24
|
| Rate for Payer: BCN Commercial |
$13,792.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Commercial |
$15,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$16,226.16
|
| Rate for Payer: Healthscope Whirlpool |
$16,728.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,898.54
|
| Rate for Payer: Mclaren Commercial |
$15,055.20
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$3,239.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$13,716.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$6,488.39
|
| Rate for Payer: PHP Medicaid |
$3,161.62
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,657.07
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Narrow Network |
$11,726.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,720.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$9,142.74
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP DNSP |
$5,898.54
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,728.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12,546.00 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$15,055.20
|
| Rate for Payer: ASR ASR |
$16,226.16
|
| Rate for Payer: BCBS Trust/PPO |
$13,737.03
|
| Rate for Payer: BCN Commercial |
$13,737.03
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Commercial |
$15,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Healthscope Commercial |
$16,226.16
|
| Rate for Payer: Healthscope Whirlpool |
$16,728.00
|
| Rate for Payer: Mclaren Commercial |
$15,055.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$13,716.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,720.64
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,728.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$15,055.20
|
| Rate for Payer: Aetna Medicare |
$5,898.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: ASR ASR |
$16,226.16
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$13,792.24
|
| Rate for Payer: BCN Commercial |
$13,792.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Commercial |
$15,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$16,226.16
|
| Rate for Payer: Healthscope Whirlpool |
$16,728.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,898.54
|
| Rate for Payer: Mclaren Commercial |
$15,055.20
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$3,239.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$13,716.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$6,488.39
|
| Rate for Payer: PHP Medicaid |
$3,161.62
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,657.07
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Narrow Network |
$11,726.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,720.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$9,142.74
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP DNSP |
$5,898.54
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: ASR ASR |
$275.96
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$234.57
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Commercial |
$267.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$275.96
|
| Rate for Payer: Healthscope Whirlpool |
$284.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.19
|
| Rate for Payer: Mclaren Commercial |
$256.05
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$119.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Nomi Health Commercial |
$233.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: PHP Medicaid |
$116.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.89
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$338.19
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP DNSP |
$218.19
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$213.38 |
| Max. Negotiated Rate |
$284.50 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: ASR ASR |
$275.96
|
| Rate for Payer: BCBS Trust/PPO |
$233.63
|
| Rate for Payer: BCN Commercial |
$233.63
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Commercial |
$267.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Healthscope Commercial |
$275.96
|
| Rate for Payer: Healthscope Whirlpool |
$284.50
|
| Rate for Payer: Mclaren Commercial |
$256.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Nomi Health Commercial |
$233.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.36
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$2,322.64 |
| Rate for Payer: Aetna Commercial |
$2,090.38
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$2,252.96
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.02
|
| Rate for Payer: BCN Commercial |
$1,915.02
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Commercial |
$2,183.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,252.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,322.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$2,090.38
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Nomi Health Commercial |
$1,904.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.77
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$80.61
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,043.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,741.98 |
| Max. Negotiated Rate |
$2,322.64 |
| Rate for Payer: Aetna Commercial |
$2,090.38
|
| Rate for Payer: ASR ASR |
$2,252.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,907.35
|
| Rate for Payer: BCN Commercial |
$1,907.35
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Commercial |
$2,183.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Healthscope Commercial |
$2,252.96
|
| Rate for Payer: Healthscope Whirlpool |
$2,322.64
|
| Rate for Payer: Mclaren Commercial |
$2,090.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Nomi Health Commercial |
$1,904.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,043.92
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$504.23 |
| Rate for Payer: Aetna Commercial |
$453.81
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$489.10
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$415.74
|
| Rate for Payer: BCN Commercial |
$415.74
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Commercial |
$473.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$489.10
|
| Rate for Payer: Healthscope Whirlpool |
$504.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$453.81
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$413.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.42
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$43.54
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$378.17 |
| Max. Negotiated Rate |
$504.23 |
| Rate for Payer: Aetna Commercial |
$453.81
|
| Rate for Payer: ASR ASR |
$489.10
|
| Rate for Payer: BCBS Trust/PPO |
$414.07
|
| Rate for Payer: BCN Commercial |
$414.07
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Commercial |
$473.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Healthscope Commercial |
$489.10
|
| Rate for Payer: Healthscope Whirlpool |
$504.23
|
| Rate for Payer: Mclaren Commercial |
$453.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$413.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.72
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,260.14 |
| Max. Negotiated Rate |
$3,013.52 |
| Rate for Payer: Aetna Commercial |
$2,712.17
|
| Rate for Payer: ASR ASR |
$2,923.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,474.70
|
| Rate for Payer: BCN Commercial |
$2,474.70
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Commercial |
$2,832.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Healthscope Commercial |
$2,923.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,013.52
|
| Rate for Payer: Mclaren Commercial |
$2,712.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Nomi Health Commercial |
$2,471.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,651.90
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$3,013.52 |
| Rate for Payer: Aetna Commercial |
$2,712.17
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$2,923.11
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,484.65
|
| Rate for Payer: BCN Commercial |
$2,484.65
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Commercial |
$2,832.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,923.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,013.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$2,712.17
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Nomi Health Commercial |
$2,471.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.77
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$80.61
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,651.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$698.77 |
| Max. Negotiated Rate |
$931.70 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: ASR ASR |
$903.75
|
| Rate for Payer: BCBS Trust/PPO |
$765.11
|
| Rate for Payer: BCN Commercial |
$765.11
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Commercial |
$875.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Healthscope Commercial |
$903.75
|
| Rate for Payer: Healthscope Whirlpool |
$931.70
|
| Rate for Payer: Mclaren Commercial |
$838.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Nomi Health Commercial |
$763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$819.90
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$931.70 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$903.75
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$768.19
|
| Rate for Payer: BCN Commercial |
$768.19
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Commercial |
$875.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$903.75
|
| Rate for Payer: Healthscope Whirlpool |
$931.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$838.53
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Nomi Health Commercial |
$763.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.42
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$43.54
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$819.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$1,151.47 |
| Rate for Payer: Aetna Commercial |
$1,036.32
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$1,116.93
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$949.39
|
| Rate for Payer: BCN Commercial |
$949.39
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Commercial |
$1,082.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,116.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$1,036.32
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Nomi Health Commercial |
$944.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.42
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$43.54
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,013.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$863.60 |
| Max. Negotiated Rate |
$1,151.47 |
| Rate for Payer: Aetna Commercial |
$1,036.32
|
| Rate for Payer: ASR ASR |
$1,116.93
|
| Rate for Payer: BCBS Trust/PPO |
$945.59
|
| Rate for Payer: BCN Commercial |
$945.59
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Commercial |
$1,082.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Healthscope Commercial |
$1,116.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.47
|
| Rate for Payer: Mclaren Commercial |
$1,036.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Nomi Health Commercial |
$944.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,013.29
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,338.34
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,442.43
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.06
|
| Rate for Payer: BCN Commercial |
$1,226.06
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Commercial |
$1,397.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,442.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,338.34
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Nomi Health Commercial |
$1,219.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.42
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$43.54
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,308.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,115.28 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,338.34
|
| Rate for Payer: ASR ASR |
$1,442.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.16
|
| Rate for Payer: BCN Commercial |
$1,221.16
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Commercial |
$1,397.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Healthscope Commercial |
$1,442.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.04
|
| Rate for Payer: Mclaren Commercial |
$1,338.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Nomi Health Commercial |
$1,219.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,308.60
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$1,842.32 |
| Rate for Payer: Aetna Commercial |
$1,658.09
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,787.05
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.99
|
| Rate for Payer: BCN Commercial |
$1,518.99
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Commercial |
$1,731.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,787.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,842.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,658.09
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Nomi Health Commercial |
$1,510.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.77
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$80.61
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,621.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,381.74 |
| Max. Negotiated Rate |
$1,842.32 |
| Rate for Payer: Aetna Commercial |
$1,658.09
|
| Rate for Payer: ASR ASR |
$1,787.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.91
|
| Rate for Payer: BCN Commercial |
$1,512.91
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Commercial |
$1,731.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Healthscope Commercial |
$1,787.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,842.32
|
| Rate for Payer: Mclaren Commercial |
$1,658.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Nomi Health Commercial |
$1,510.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,621.24
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna Commercial |
$101.12
|
| Rate for Payer: Aetna Medicare |
$41.57
|
| Rate for Payer: ASR ASR |
$108.99
|
| Rate for Payer: BCBS Complete |
$44.94
|
| Rate for Payer: BCBS Trust/PPO |
$92.64
|
| Rate for Payer: BCN Commercial |
$92.64
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$105.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$108.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.36
|
| Rate for Payer: Mclaren Commercial |
$101.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Nomi Health Commercial |
$92.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.45
|
| Rate for Payer: Priority Health Narrow Network |
$78.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.88
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna Commercial |
$101.12
|
| Rate for Payer: ASR ASR |
$108.99
|
| Rate for Payer: BCBS Trust/PPO |
$92.27
|
| Rate for Payer: BCN Commercial |
$92.27
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$105.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$108.99
|
| Rate for Payer: Healthscope Whirlpool |
$112.36
|
| Rate for Payer: Mclaren Commercial |
$101.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Nomi Health Commercial |
$92.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.88
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$257.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$257.66 |
| Rate for Payer: Aetna Commercial |
$231.89
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$249.93
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$212.44
|
| Rate for Payer: BCN Commercial |
$212.44
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cofinity Commercial |
$242.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$249.93
|
| Rate for Payer: Healthscope Whirlpool |
$257.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$231.89
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.01
|
| Rate for Payer: Nomi Health Commercial |
$211.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.25
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.76
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$180.62
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
