|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$35.46 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: Meridian Medicaid |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$35.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.82
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health SBD |
$10.03
|
| Rate for Payer: Priority Health Tiered Network |
$9.46
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.73
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.82
|
| Rate for Payer: UHC Exchange |
$17.73
|
| Rate for Payer: UHC Medicaid |
$6.18
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health SBD |
$10.03
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$213.18
|
| Rate for Payer: BCN Commercial |
$213.18
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Advantage |
$151.49
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$136.34
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.67
|
| Rate for Payer: UHC Core |
$112.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$85.05
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.67
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Advantage |
$151.49
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: Priority Health SBD |
$136.34
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$261.25
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$164.59 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.81
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Advantage |
$182.88
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.94
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: Priority Health SBD |
$164.59
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$261.25
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Aetna Commercial |
$222.06
|
| Rate for Payer: Aetna Medicare |
$130.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.81
|
| Rate for Payer: BCBS Complete |
$104.50
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cofinity Advantage |
$182.88
|
| Rate for Payer: Cofinity Commercial |
$224.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.00
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.94
|
| Rate for Payer: PHP Commercial |
$222.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.96
|
| Rate for Payer: Priority Health SBD |
$164.59
|
| Rate for Payer: Priority Health Tiered Network |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.81
|
| Rate for Payer: UHC Core |
$136.11
|
| Rate for Payer: UHC Exchange |
$102.67
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$701.60
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$596.36
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$196.91
|
| Rate for Payer: BCN Commercial |
$196.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cofinity Advantage |
$491.12
|
| Rate for Payer: Cofinity Commercial |
$603.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$631.44
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.36
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.20
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$596.36
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$442.01
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.04
|
| Rate for Payer: UHC Core |
$365.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$275.73
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$701.60
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$631.44 |
| Rate for Payer: Aetna Commercial |
$596.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.04
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cofinity Advantage |
$491.12
|
| Rate for Payer: Cofinity Commercial |
$603.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.28
|
| Rate for Payer: Healthscope Commercial |
$631.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.20
|
| Rate for Payer: PHP Commercial |
$596.36
|
| Rate for Payer: Priority Health SBD |
$442.01
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$701.60
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$442.01 |
| Max. Negotiated Rate |
$631.44 |
| Rate for Payer: Aetna Commercial |
$596.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.04
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cofinity Advantage |
$491.12
|
| Rate for Payer: Cofinity Commercial |
$603.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.28
|
| Rate for Payer: Healthscope Commercial |
$631.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.20
|
| Rate for Payer: PHP Commercial |
$596.36
|
| Rate for Payer: Priority Health SBD |
$442.01
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$701.60
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$596.36
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$248.73
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cash Price |
$561.28
|
| Rate for Payer: Cofinity Advantage |
$491.12
|
| Rate for Payer: Cofinity Commercial |
$603.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$631.44
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.36
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.20
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$596.36
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$442.01
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.04
|
| Rate for Payer: UHC Core |
$365.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$275.73
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$171.67
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$145.92
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$137.34
|
| Rate for Payer: Cash Price |
$137.34
|
| Rate for Payer: Cofinity Advantage |
$120.17
|
| Rate for Payer: Cofinity Commercial |
$147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$154.50
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.92
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.75
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$145.92
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$108.15
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.59
|
| Rate for Payer: UHC Core |
$89.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$67.47
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$171.67
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Aetna Commercial |
$145.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.59
|
| Rate for Payer: Cash Price |
$137.34
|
| Rate for Payer: Cofinity Advantage |
$120.17
|
| Rate for Payer: Cofinity Commercial |
$147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.34
|
| Rate for Payer: Healthscope Commercial |
$154.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.75
|
| Rate for Payer: PHP Commercial |
$145.92
|
| Rate for Payer: Priority Health SBD |
$108.15
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$61.17
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna Medicare |
$30.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.76
|
| Rate for Payer: BCBS Complete |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$54.79
|
| Rate for Payer: BCN Commercial |
$54.79
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$42.82
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$55.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.88
|
| Rate for Payer: PHP Commercial |
$51.99
|
| Rate for Payer: Priority Health SBD |
$38.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.76
|
| Rate for Payer: UHC Core |
$31.87
|
| Rate for Payer: UHC Exchange |
$24.04
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$61.17
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.76
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Advantage |
$42.82
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$55.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.88
|
| Rate for Payer: PHP Commercial |
$51.99
|
| Rate for Payer: Priority Health SBD |
$38.54
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$56.21
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: Priority Health SBD |
$35.41
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$56.21
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.09 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: BCBS Complete |
$22.48
|
| Rate for Payer: BCBS Trust/PPO |
$45.89
|
| Rate for Payer: BCN Commercial |
$45.89
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: Priority Health SBD |
$35.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.54
|
| Rate for Payer: UHC Core |
$29.29
|
| Rate for Payer: UHC Exchange |
$22.09
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$472.72
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$425.45 |
| Rate for Payer: Aetna Commercial |
$401.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.27
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Advantage |
$330.90
|
| Rate for Payer: Cofinity Commercial |
$406.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Healthscope Commercial |
$425.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| Rate for Payer: PHP Commercial |
$401.81
|
| Rate for Payer: Priority Health SBD |
$297.81
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$472.72
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$401.81
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$128.81
|
| Rate for Payer: BCN Commercial |
$128.81
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cash Price |
$378.18
|
| Rate for Payer: Cofinity Advantage |
$330.90
|
| Rate for Payer: Cofinity Commercial |
$406.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$425.45
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.81
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.54
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$401.81
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$297.81
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.27
|
| Rate for Payer: UHC Core |
$246.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$185.78
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AUTOIMMUNE DIABETES CMPT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Commercial |
$25.13
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Advantage |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.40
|
| Rate for Payer: Nomi Health Commercial |
$35.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.57
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$27.72
|
| Rate for Payer: Priority Health Tiered Network |
$18.86
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.36
|
| Rate for Payer: UHC Core |
$35.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$35.36
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC AUTOIMMUNE DIABETES CMPT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Advantage |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: Priority Health SBD |
$27.72
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$841.79
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$757.61 |
| Rate for Payer: Aetna Commercial |
$715.52
|
| Rate for Payer: Aetna Medicare |
$152.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.56
|
| Rate for Payer: BCBS Complete |
$80.65
|
| Rate for Payer: BCBS MAPPO |
$146.85
|
| Rate for Payer: BCBS Trust/PPO |
$401.17
|
| Rate for Payer: BCN Commercial |
$401.17
|
| Rate for Payer: BCN Medicare Advantage |
$146.85
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Advantage |
$589.25
|
| Rate for Payer: Cofinity Commercial |
$723.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.85
|
| Rate for Payer: Healthscope Commercial |
$757.61
|
| Rate for Payer: Mclaren Medicaid |
$76.80
|
| Rate for Payer: Mclaren Medicare |
$146.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.19
|
| Rate for Payer: Meridian Medicaid |
$154.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Nomi Health Commercial |
$440.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: PACE Medicare |
$139.51
|
| Rate for Payer: PACE SWMI |
$146.85
|
| Rate for Payer: PHP Commercial |
$715.52
|
| Rate for Payer: PHP Medicare Advantage |
$146.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$474.89
|
| Rate for Payer: Priority Health Medicare |
$146.85
|
| Rate for Payer: Priority Health SBD |
$530.33
|
| Rate for Payer: Priority Health Tiered Network |
$379.91
|
| Rate for Payer: Railroad Medicare Medicare |
$146.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.16
|
| Rate for Payer: UHC Core |
$438.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.85
|
| Rate for Payer: UHC Exchange |
$330.82
|
| Rate for Payer: UHC Medicaid |
$76.80
|
| Rate for Payer: UHCCP Medicaid |
$76.80
|
| Rate for Payer: VA VA |
$146.85
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$841.79
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$530.33 |
| Max. Negotiated Rate |
$757.61 |
| Rate for Payer: Aetna Commercial |
$715.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.16
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Advantage |
$589.25
|
| Rate for Payer: Cofinity Commercial |
$723.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Healthscope Commercial |
$757.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: PHP Commercial |
$715.52
|
| Rate for Payer: Priority Health SBD |
$530.33
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$185.16
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$116.65 |
| Max. Negotiated Rate |
$166.64 |
| Rate for Payer: Aetna Commercial |
$157.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.35
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cofinity Advantage |
$129.61
|
| Rate for Payer: Cofinity Commercial |
$159.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.13
|
| Rate for Payer: Healthscope Commercial |
$166.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.87
|
| Rate for Payer: PHP Commercial |
$157.39
|
| Rate for Payer: Priority Health SBD |
$116.65
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$185.16
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$157.39
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$195.41
|
| Rate for Payer: BCN Commercial |
$195.41
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cofinity Advantage |
$129.61
|
| Rate for Payer: Cofinity Commercial |
$159.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$166.64
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.39
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.87
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$157.39
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$116.65
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.35
|
| Rate for Payer: UHC Core |
$96.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$72.77
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$370.31
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$314.76
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$190.99
|
| Rate for Payer: BCN Commercial |
$190.99
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cofinity Advantage |
$259.22
|
| Rate for Payer: Cofinity Commercial |
$318.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$333.28
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.76
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.73
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$314.76
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$233.30
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.70
|
| Rate for Payer: UHC Core |
$192.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$145.53
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
