|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,806.20
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,174.03 |
| Max. Negotiated Rate |
$1,806.20 |
| Rate for Payer: Aetna Commercial |
$1,625.58
|
| Rate for Payer: ASR ASR |
$1,752.01
|
| Rate for Payer: ASR Commercial |
$1,752.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.87
|
| Rate for Payer: BCN Commercial |
$1,400.35
|
| 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: Healthscope Commercial |
$1,806.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,752.01
|
| Rate for Payer: Mclaren Commercial |
$1,625.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,535.27
|
| Rate for Payer: Nomi Health Commercial |
$1,481.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,589.46
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$110.16
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: ASR ASR |
$106.86
|
| Rate for Payer: ASR Commercial |
$106.86
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$85.41
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$103.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Healthscope Whirlpool |
$106.86
|
| Rate for Payer: Mclaren Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Nomi Health Commercial |
$90.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.52
|
| Rate for Payer: Priority Health Narrow Network |
$77.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.94
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$110.16
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: ASR ASR |
$106.86
|
| Rate for Payer: ASR Commercial |
$106.86
|
| Rate for Payer: BCBS Trust/PPO |
$89.77
|
| Rate for Payer: BCN Commercial |
$85.41
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Commercial |
$103.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Healthscope Whirlpool |
$106.86
|
| Rate for Payer: Mclaren Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Nomi Health Commercial |
$90.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.94
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$252.61
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$252.61 |
| Rate for Payer: Aetna Commercial |
$227.35
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$245.03
|
| Rate for Payer: ASR Commercial |
$245.03
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$206.86
|
| Rate for Payer: BCN Commercial |
$195.85
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cofinity Commercial |
$237.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$252.61
|
| Rate for Payer: Healthscope Whirlpool |
$245.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$227.35
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.72
|
| Rate for Payer: Nomi Health Commercial |
$207.14
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.34
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$177.08
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
IP
|
$252.61
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$252.61 |
| Rate for Payer: Aetna Commercial |
$227.35
|
| Rate for Payer: ASR ASR |
$245.03
|
| Rate for Payer: ASR Commercial |
$245.03
|
| Rate for Payer: BCBS Trust/PPO |
$205.85
|
| Rate for Payer: BCN Commercial |
$195.85
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cofinity Commercial |
$237.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.09
|
| Rate for Payer: Healthscope Commercial |
$252.61
|
| Rate for Payer: Healthscope Whirlpool |
$245.03
|
| Rate for Payer: Mclaren Commercial |
$227.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.72
|
| Rate for Payer: Nomi Health Commercial |
$207.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.30
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$73.90
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Aetna Commercial |
$66.51
|
| Rate for Payer: ASR ASR |
$71.68
|
| Rate for Payer: ASR Commercial |
$71.68
|
| Rate for Payer: BCBS Trust/PPO |
$60.22
|
| Rate for Payer: BCN Commercial |
$57.29
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cofinity Commercial |
$69.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$73.90
|
| Rate for Payer: Healthscope Whirlpool |
$71.68
|
| Rate for Payer: Mclaren Commercial |
$66.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.81
|
| Rate for Payer: Nomi Health Commercial |
$60.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.03
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$73.90
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Aetna Commercial |
$66.51
|
| Rate for Payer: Aetna Medicare |
$36.95
|
| Rate for Payer: ASR ASR |
$71.68
|
| Rate for Payer: ASR Commercial |
$71.68
|
| Rate for Payer: BCBS Complete |
$29.56
|
| Rate for Payer: BCBS Trust/PPO |
$60.52
|
| Rate for Payer: BCN Commercial |
$57.29
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cofinity Commercial |
$69.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$73.90
|
| Rate for Payer: Healthscope Whirlpool |
$71.68
|
| Rate for Payer: Mclaren Commercial |
$66.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.81
|
| Rate for Payer: Nomi Health Commercial |
$60.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.75
|
| Rate for Payer: Priority Health Narrow Network |
$51.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.03
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC NEEDLE INSERT W/O INJECT 1 OR 2 MUSCLES
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 1 OR 2 MUSCLES
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC NEEDLE INSERT W/O INJECTION, 3 OR MORE MUSCLES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$26.53
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: ASR Commercial |
$51.47
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$43.45
|
| Rate for Payer: BCN Commercial |
$41.14
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$53.06
|
| Rate for Payer: Healthscope Whirlpool |
$51.47
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC NEEDLE LOC WIRE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
HCPCS C1819
|
| Hospital Charge Code |
27200323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.49 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: ASR Commercial |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.24
|
| Rate for Payer: BCN Commercial |
$41.14
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$53.06
|
| Rate for Payer: Healthscope Whirlpool |
$51.47
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
OP
|
$233.19
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$233.19 |
| Rate for Payer: Aetna Commercial |
$209.87
|
| Rate for Payer: Aetna Medicare |
$116.59
|
| Rate for Payer: ASR ASR |
$226.19
|
| Rate for Payer: ASR Commercial |
$226.19
|
| Rate for Payer: BCBS Complete |
$93.28
|
| Rate for Payer: BCBS Trust/PPO |
$190.96
|
| Rate for Payer: BCN Commercial |
$180.79
|
| Rate for Payer: Cash Price |
$186.55
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.55
|
| Rate for Payer: Healthscope Commercial |
$233.19
|
| Rate for Payer: Healthscope Whirlpool |
$226.19
|
| Rate for Payer: Mclaren Commercial |
$209.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.21
|
| Rate for Payer: Nomi Health Commercial |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.32
|
| Rate for Payer: Priority Health Narrow Network |
$163.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.21
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
IP
|
$233.19
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.57 |
| Max. Negotiated Rate |
$233.19 |
| Rate for Payer: Aetna Commercial |
$209.87
|
| Rate for Payer: ASR ASR |
$226.19
|
| Rate for Payer: ASR Commercial |
$226.19
|
| Rate for Payer: BCBS Trust/PPO |
$190.03
|
| Rate for Payer: BCN Commercial |
$180.79
|
| Rate for Payer: Cash Price |
$186.55
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.55
|
| Rate for Payer: Healthscope Commercial |
$233.19
|
| Rate for Payer: Healthscope Whirlpool |
$226.19
|
| Rate for Payer: Mclaren Commercial |
$209.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.21
|
| Rate for Payer: Nomi Health Commercial |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.21
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
IP
|
$151.46
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.45 |
| Max. Negotiated Rate |
$151.46 |
| Rate for Payer: Aetna Commercial |
$136.31
|
| Rate for Payer: ASR ASR |
$146.92
|
| Rate for Payer: ASR Commercial |
$146.92
|
| Rate for Payer: BCBS Trust/PPO |
$123.42
|
| Rate for Payer: BCN Commercial |
$117.43
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$142.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.17
|
| Rate for Payer: Healthscope Commercial |
$151.46
|
| Rate for Payer: Healthscope Whirlpool |
$146.92
|
| Rate for Payer: Mclaren Commercial |
$136.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.28
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
OP
|
$151.46
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$151.46 |
| Rate for Payer: Aetna Commercial |
$136.31
|
| Rate for Payer: Aetna Medicare |
$75.73
|
| Rate for Payer: ASR ASR |
$146.92
|
| Rate for Payer: ASR Commercial |
$146.92
|
| Rate for Payer: BCBS Complete |
$60.58
|
| Rate for Payer: BCBS Trust/PPO |
$124.03
|
| Rate for Payer: BCN Commercial |
$117.43
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$142.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.17
|
| Rate for Payer: Healthscope Commercial |
$151.46
|
| Rate for Payer: Healthscope Whirlpool |
$146.92
|
| Rate for Payer: Mclaren Commercial |
$136.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.71
|
| Rate for Payer: Priority Health Narrow Network |
$106.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.28
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
OP
|
$510.90
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$510.90 |
| Rate for Payer: Aetna Commercial |
$459.81
|
| Rate for Payer: Aetna Medicare |
$255.45
|
| Rate for Payer: ASR ASR |
$495.57
|
| Rate for Payer: ASR Commercial |
$495.57
|
| Rate for Payer: BCBS Complete |
$204.36
|
| Rate for Payer: BCBS Trust/PPO |
$418.38
|
| Rate for Payer: BCN Commercial |
$396.10
|
| Rate for Payer: Cash Price |
$408.72
|
| Rate for Payer: Cofinity Commercial |
$480.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.72
|
| Rate for Payer: Healthscope Commercial |
$510.90
|
| Rate for Payer: Healthscope Whirlpool |
$495.57
|
| Rate for Payer: Mclaren Commercial |
$459.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.26
|
| Rate for Payer: Nomi Health Commercial |
$418.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.65
|
| Rate for Payer: Priority Health Narrow Network |
$358.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.59
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
IP
|
$510.90
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.08 |
| Max. Negotiated Rate |
$510.90 |
| Rate for Payer: Aetna Commercial |
$459.81
|
| Rate for Payer: ASR ASR |
$495.57
|
| Rate for Payer: ASR Commercial |
$495.57
|
| Rate for Payer: BCBS Trust/PPO |
$416.33
|
| Rate for Payer: BCN Commercial |
$396.10
|
| Rate for Payer: Cash Price |
$408.72
|
| Rate for Payer: Cofinity Commercial |
$480.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.72
|
| Rate for Payer: Healthscope Commercial |
$510.90
|
| Rate for Payer: Healthscope Whirlpool |
$495.57
|
| Rate for Payer: Mclaren Commercial |
$459.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.26
|
| Rate for Payer: Nomi Health Commercial |
$418.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.59
|
|
|
HC NEG PRESSURE DERMATAC DRAPE
|
Facility
|
IP
|
$64.50
|
|
| Hospital Charge Code |
27200374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: ASR Commercial |
$62.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.56
|
| Rate for Payer: BCN Commercial |
$50.01
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$64.50
|
| Rate for Payer: Healthscope Whirlpool |
$62.56
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC NEG PRESSURE DERMATAC DRAPE
|
Facility
|
OP
|
$64.50
|
|
| Hospital Charge Code |
27200374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: ASR Commercial |
$62.56
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.82
|
| Rate for Payer: BCN Commercial |
$50.01
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$64.50
|
| Rate for Payer: Healthscope Whirlpool |
$62.56
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
OP
|
$540.83
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$486.75
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$524.61
|
| Rate for Payer: ASR Commercial |
$524.61
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$442.89
|
| Rate for Payer: BCN Commercial |
$419.31
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cofinity Commercial |
$508.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$540.83
|
| Rate for Payer: Healthscope Whirlpool |
$524.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$486.75
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.71
|
| Rate for Payer: Nomi Health Commercial |
$443.48
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473.88
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$379.12
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
IP
|
$540.83
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.54 |
| Max. Negotiated Rate |
$540.83 |
| Rate for Payer: Aetna Commercial |
$486.75
|
| Rate for Payer: ASR ASR |
$524.61
|
| Rate for Payer: ASR Commercial |
$524.61
|
| Rate for Payer: BCBS Trust/PPO |
$440.72
|
| Rate for Payer: BCN Commercial |
$419.31
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cofinity Commercial |
$508.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.66
|
| Rate for Payer: Healthscope Commercial |
$540.83
|
| Rate for Payer: Healthscope Whirlpool |
$524.61
|
| Rate for Payer: Mclaren Commercial |
$486.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.71
|
| Rate for Payer: Nomi Health Commercial |
$443.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.93
|
|
