|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,884.05 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Commercial |
$3,993.30
|
| Rate for Payer: ASR ASR |
$4,303.89
|
| Rate for Payer: ASR Commercial |
$4,303.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,615.71
|
| Rate for Payer: BCN Commercial |
$3,440.01
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$4,170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Healthscope Commercial |
$4,437.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,303.89
|
| Rate for Payer: Mclaren Commercial |
$3,993.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,904.56
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Commercial |
$3,993.30
|
| Rate for Payer: Aetna Medicare |
$1,681.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: ASR ASR |
$4,303.89
|
| Rate for Payer: ASR Commercial |
$4,303.89
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,633.46
|
| Rate for Payer: BCN Commercial |
$3,440.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$4,170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Healthscope Commercial |
$4,437.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,303.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,681.84
|
| Rate for Payer: Mclaren Commercial |
$3,993.30
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Commercial |
$1,850.02
|
| Rate for Payer: PHP Medicaid |
$901.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,887.70
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Priority Health Narrow Network |
$3,110.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,904.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$2,606.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP DNSP |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$255.90 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Trust/PPO |
$208.53
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$293.48 |
| Rate for Payer: Aetna Commercial |
$230.31
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: ASR ASR |
$248.22
|
| Rate for Payer: ASR Commercial |
$248.22
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$240.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$255.90
|
| Rate for Payer: Healthscope Whirlpool |
$248.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.34
|
| Rate for Payer: Mclaren Commercial |
$230.31
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$208.27
|
| Rate for Payer: PHP Medicaid |
$101.49
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.22
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health Narrow Network |
$179.39
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$293.48
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP DNSP |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: VA VA |
$189.34
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: Aetna Medicare |
$5,769.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCBS Trust/PPO |
$13,429.96
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,769.42
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$6,346.36
|
| Rate for Payer: PHP Medicaid |
$3,092.41
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,369.68
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health Narrow Network |
$11,496.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$8,942.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP DNSP |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,364.36
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,364.36
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,400.00 |
| Rate for Payer: Aetna Commercial |
$14,760.00
|
| Rate for Payer: Aetna Medicare |
$5,769.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: ASR ASR |
$15,908.00
|
| Rate for Payer: ASR Commercial |
$15,908.00
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCBS Trust/PPO |
$13,429.96
|
| Rate for Payer: BCN Commercial |
$12,714.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$15,416.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$16,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,908.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,769.42
|
| Rate for Payer: Mclaren Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$6,346.36
|
| Rate for Payer: PHP Medicaid |
$3,092.41
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,369.68
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health Narrow Network |
$11,496.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,432.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$8,942.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP DNSP |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$278.92 |
| Rate for Payer: Aetna Commercial |
$251.03
|
| Rate for Payer: ASR ASR |
$270.55
|
| Rate for Payer: ASR Commercial |
$270.55
|
| Rate for Payer: BCBS Trust/PPO |
$227.29
|
| Rate for Payer: BCN Commercial |
$216.25
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$262.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Healthscope Commercial |
$278.92
|
| Rate for Payer: Healthscope Whirlpool |
$270.55
|
| Rate for Payer: Mclaren Commercial |
$251.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.45
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$307.46 |
| Rate for Payer: Aetna Commercial |
$251.03
|
| Rate for Payer: Aetna Medicare |
$198.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$270.55
|
| Rate for Payer: ASR Commercial |
$270.55
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCBS Trust/PPO |
$228.41
|
| Rate for Payer: BCN Commercial |
$216.25
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$262.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$278.92
|
| Rate for Payer: Healthscope Whirlpool |
$270.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$198.36
|
| Rate for Payer: Mclaren Commercial |
$251.03
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicaid |
$106.32
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.39
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health Narrow Network |
$195.52
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$307.46
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP DNSP |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,480.12 |
| Max. Negotiated Rate |
$2,277.10 |
| Rate for Payer: Aetna Commercial |
$2,049.39
|
| Rate for Payer: ASR ASR |
$2,208.79
|
| Rate for Payer: ASR Commercial |
$2,208.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.61
|
| Rate for Payer: BCN Commercial |
$1,765.44
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$2,140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$2,277.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.79
|
| Rate for Payer: Mclaren Commercial |
$2,049.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.85
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,277.10 |
| Rate for Payer: Aetna Commercial |
$2,049.39
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,208.79
|
| Rate for Payer: ASR Commercial |
$2,208.79
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.72
|
| Rate for Payer: BCN Commercial |
$1,765.44
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$2,140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,277.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,208.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,049.39
|
| 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 |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| 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 |
$1,480.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,995.20
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.25
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,003.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$494.34 |
| Rate for Payer: Aetna Commercial |
$444.91
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$479.51
|
| Rate for Payer: ASR Commercial |
$479.51
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$404.82
|
| Rate for Payer: BCN Commercial |
$383.26
|
| 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 |
$464.68
|
| 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 |
$494.34
|
| Rate for Payer: Healthscope Whirlpool |
$479.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$405.36
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| 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 HMO/PPO/Tiered Network |
$433.14
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$346.53
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
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 |
$321.32 |
| Max. Negotiated Rate |
$494.34 |
| Rate for Payer: Aetna Commercial |
$444.91
|
| Rate for Payer: ASR ASR |
$479.51
|
| Rate for Payer: ASR Commercial |
$479.51
|
| Rate for Payer: BCBS Trust/PPO |
$402.84
|
| Rate for Payer: BCN Commercial |
$383.26
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$464.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Healthscope Commercial |
$494.34
|
| Rate for Payer: Healthscope Whirlpool |
$479.51
|
| Rate for Payer: Mclaren Commercial |
$444.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: Nomi Health Commercial |
$405.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.02
|
|
|
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 |
$2,954.43 |
| Rate for Payer: Aetna Commercial |
$2,658.99
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,865.80
|
| Rate for Payer: ASR Commercial |
$2,865.80
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.38
|
| Rate for Payer: BCN Commercial |
$2,290.57
|
| 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 |
$2,777.16
|
| 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 |
$2,954.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,865.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$2,422.63
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| 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 HMO/PPO/Tiered Network |
$2,588.67
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,071.06
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,599.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
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 |
$1,920.38 |
| Max. Negotiated Rate |
$2,954.43 |
| Rate for Payer: Aetna Commercial |
$2,658.99
|
| Rate for Payer: ASR ASR |
$2,865.80
|
| Rate for Payer: ASR Commercial |
$2,865.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,407.57
|
| Rate for Payer: BCN Commercial |
$2,290.57
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,777.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Healthscope Commercial |
$2,954.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,865.80
|
| Rate for Payer: Mclaren Commercial |
$2,658.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: Nomi Health Commercial |
$2,422.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,599.90
|
|
|
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 |
$913.43 |
| Rate for Payer: Aetna Commercial |
$822.09
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$886.03
|
| Rate for Payer: ASR Commercial |
$886.03
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$748.01
|
| Rate for Payer: BCN Commercial |
$708.18
|
| 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 |
$858.62
|
| 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 |
$913.43
|
| Rate for Payer: Healthscope Whirlpool |
$886.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$749.01
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| 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 HMO/PPO/Tiered Network |
$800.35
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$640.31
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$593.73 |
| Max. Negotiated Rate |
$913.43 |
| Rate for Payer: Aetna Commercial |
$822.09
|
| Rate for Payer: ASR ASR |
$886.03
|
| Rate for Payer: ASR Commercial |
$886.03
|
| Rate for Payer: BCBS Trust/PPO |
$744.35
|
| Rate for Payer: BCN Commercial |
$708.18
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$858.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Healthscope Commercial |
$913.43
|
| Rate for Payer: Healthscope Whirlpool |
$886.03
|
| Rate for Payer: Mclaren Commercial |
$822.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Nomi Health Commercial |
$749.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.82
|
|
|
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 |
$733.78 |
| Max. Negotiated Rate |
$1,128.89 |
| Rate for Payer: Aetna Commercial |
$1,016.00
|
| Rate for Payer: ASR ASR |
$1,095.02
|
| Rate for Payer: ASR Commercial |
$1,095.02
|
| Rate for Payer: BCBS Trust/PPO |
$919.93
|
| Rate for Payer: BCN Commercial |
$875.23
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$1,061.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Healthscope Commercial |
$1,128.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.02
|
| Rate for Payer: Mclaren Commercial |
$1,016.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: Nomi Health Commercial |
$925.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.42
|
|
|
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 |
$1,128.89 |
| Rate for Payer: Aetna Commercial |
$1,016.00
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,095.02
|
| Rate for Payer: ASR Commercial |
$1,095.02
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$924.45
|
| Rate for Payer: BCN Commercial |
$875.23
|
| 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 |
$1,061.16
|
| 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 |
$1,128.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$925.69
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| 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 HMO/PPO/Tiered Network |
$989.13
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$791.35
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
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 |
$1,457.88 |
| Rate for Payer: Aetna Commercial |
$1,312.09
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$1,414.14
|
| Rate for Payer: ASR Commercial |
$1,414.14
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.86
|
| Rate for Payer: BCN Commercial |
$1,130.29
|
| 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 |
$1,370.41
|
| 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 |
$1,457.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,414.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$1,195.46
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| 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 HMO/PPO/Tiered Network |
$1,277.39
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,021.97
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,282.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| 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 |
$947.62 |
| Max. Negotiated Rate |
$1,457.88 |
| Rate for Payer: Aetna Commercial |
$1,312.09
|
| Rate for Payer: ASR ASR |
$1,414.14
|
| Rate for Payer: ASR Commercial |
$1,414.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.03
|
| Rate for Payer: BCN Commercial |
$1,130.29
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cofinity Commercial |
$1,370.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.30
|
| Rate for Payer: Healthscope Commercial |
$1,457.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,414.14
|
| Rate for Payer: Mclaren Commercial |
$1,312.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.20
|
| Rate for Payer: Nomi Health Commercial |
$1,195.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,282.93
|
|
|
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 |
$1,806.20 |
| Rate for Payer: Aetna Commercial |
$1,625.58
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$1,752.01
|
| Rate for Payer: ASR Commercial |
$1,752.01
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.10
|
| Rate for Payer: BCN Commercial |
$1,400.35
|
| 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 |
$1,697.83
|
| 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 |
$1,806.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,752.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$1,481.08
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| 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 HMO/PPO/Tiered Network |
$1,582.59
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,266.15
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,589.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
