|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$824.04 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$276.30
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Cofinity Commercial |
$472.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$424.84
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$110.02
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$424.84 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.33
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Cofinity Commercial |
$472.04
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health SBD |
$424.84
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health SBD |
$103.95
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$103.95
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Aetna Commercial |
$49.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.21
|
| Rate for Payer: BCBS Complete |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$53.73
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$50.56
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Healthscope Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: PHP Commercial |
$49.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health SBD |
$37.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC Exchange |
$12.44
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$49.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.21
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Commercial |
$50.56
|
| Rate for Payer: Healthscope Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: PHP Commercial |
$49.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health SBD |
$37.04
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$49.14 |
| Rate for Payer: Aetna Commercial |
$45.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.12
|
| Rate for Payer: BCBS Complete |
$21.61
|
| Rate for Payer: BCBS Trust/PPO |
$49.14
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$46.47
|
| Rate for Payer: Healthscope Commercial |
$48.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: PHP Commercial |
$45.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: Priority Health SBD |
$34.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.53
|
| Rate for Payer: UHC Exchange |
$10.48
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.04 |
| Max. Negotiated Rate |
$48.63 |
| Rate for Payer: Aetna Commercial |
$45.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.12
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$46.47
|
| Rate for Payer: Healthscope Commercial |
$48.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: PHP Commercial |
$45.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: Priority Health SBD |
$34.04
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$286.25 |
| Max. Negotiated Rate |
$408.92 |
| Rate for Payer: Aetna Commercial |
$386.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.33
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$318.05
|
| Rate for Payer: Cofinity Commercial |
$390.75
|
| Rate for Payer: Healthscope Commercial |
$408.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: PHP Commercial |
$386.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: Priority Health SBD |
$286.25
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$386.21
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$145.84
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$390.75
|
| Rate for Payer: Cofinity Commercial |
$318.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$408.92
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$386.21
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$286.25
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$809.10
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.92
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Cofinity Commercial |
$566.37
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health SBD |
$509.73
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$809.10
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: Aetna Medicare |
$132.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.35
|
| Rate for Payer: BCBS Complete |
$73.22
|
| Rate for Payer: BCBS MAPPO |
$127.48
|
| Rate for Payer: BCBS Trust/PPO |
$393.78
|
| Rate for Payer: BCN Medicare Advantage |
$127.48
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Cofinity Commercial |
$566.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.48
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$127.48
|
| Rate for Payer: Meridian Medicaid |
$73.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PACE Medicare |
$121.11
|
| Rate for Payer: PACE SWMI |
$127.48
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: PHP Medicare Advantage |
$127.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.37
|
| Rate for Payer: Priority Health Medicare |
$127.48
|
| Rate for Payer: Priority Health Narrow Network |
$325.10
|
| Rate for Payer: Priority Health SBD |
$509.73
|
| Rate for Payer: Railroad Medicare Medicare |
$127.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.48
|
| Rate for Payer: UHC Medicare Advantage |
$131.30
|
| Rate for Payer: VA VA |
$127.48
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$177.97
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$160.17 |
| Rate for Payer: Aetna Commercial |
$151.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.68
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$153.05
|
| Rate for Payer: Cofinity Commercial |
$124.58
|
| Rate for Payer: Healthscope Commercial |
$160.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.27
|
| Rate for Payer: PHP Commercial |
$151.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.58
|
| Rate for Payer: Priority Health SBD |
$112.12
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$177.97
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$151.27
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$236.41
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cofinity Commercial |
$153.05
|
| Rate for Payer: Cofinity Commercial |
$124.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$160.17
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.27
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$151.27
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$112.12
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$92.99
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$355.93
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$320.34 |
| Rate for Payer: Aetna Commercial |
$302.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.35
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Cofinity Commercial |
$306.10
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PHP Commercial |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health SBD |
$224.24
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$355.93
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$302.54
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$199.56
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Cofinity Commercial |
$306.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$302.54
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$224.24
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$86.12
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$355.93
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$320.34 |
| Rate for Payer: Aetna Commercial |
$302.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.35
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Cofinity Commercial |
$306.10
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PHP Commercial |
$302.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health SBD |
$224.24
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$355.93
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$363.82 |
| Rate for Payer: Aetna Commercial |
$302.54
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$363.82
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cash Price |
$284.74
|
| Rate for Payer: Cofinity Commercial |
$249.15
|
| Rate for Payer: Cofinity Commercial |
$306.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.54
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$302.54
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$224.24
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$119.84
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$508.47
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$457.62 |
| Rate for Payer: Aetna Commercial |
$432.20
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$302.43
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cofinity Commercial |
$437.28
|
| Rate for Payer: Cofinity Commercial |
$355.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$457.62
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.20
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$432.20
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.93
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$320.34
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$508.47
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$320.34 |
| Max. Negotiated Rate |
$457.62 |
| Rate for Payer: Aetna Commercial |
$432.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.51
|
| Rate for Payer: Cash Price |
$406.78
|
| Rate for Payer: Cofinity Commercial |
$355.93
|
| Rate for Payer: Cofinity Commercial |
$437.28
|
| Rate for Payer: Healthscope Commercial |
$457.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$432.20
|
| Rate for Payer: PHP Commercial |
$432.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.93
|
| Rate for Payer: Priority Health SBD |
$320.34
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$311.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$264.64
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$217.94
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$280.21
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.64
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$264.64
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$196.14
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
IP
|
$311.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.14 |
| Max. Negotiated Rate |
$280.21 |
| Rate for Payer: Aetna Commercial |
$264.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.37
|
| Rate for Payer: Cash Price |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$217.94
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$280.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.64
|
| Rate for Payer: PHP Commercial |
$264.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.94
|
| Rate for Payer: Priority Health SBD |
$196.14
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.18
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: PHP Commercial |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.02
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna Commercial |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.18
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: PHP Commercial |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.02
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.37
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna Commercial |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.74
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$26.12
|
| Rate for Payer: Healthscope Commercial |
$27.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.81
|
| Rate for Payer: PHP Commercial |
$25.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$19.13
|
|
