|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$133.67
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$157.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$157.01
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$230.52 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna Medicare |
$128.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.48
|
| Rate for Payer: BCBS Complete |
$102.45
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$179.29
|
| Rate for Payer: Cofinity Commercial |
$220.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: PHP Commercial |
$217.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: Priority Health SBD |
$161.36
|
| Rate for Payer: UHC Core |
$189.54
|
| Rate for Payer: UHC Exchange |
$189.54
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$161.36 |
| Max. Negotiated Rate |
$230.52 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.48
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$179.29
|
| Rate for Payer: Cofinity Commercial |
$220.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: PHP Commercial |
$217.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: Priority Health SBD |
$161.36
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$433.34
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$509.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$509.00
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$433.34 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health SBD |
$433.34
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$433.34
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$509.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$509.00
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$433.34 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.10
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$481.49
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health SBD |
$433.34
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.39
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$106.03
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$124.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$124.54
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$106.03 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.39
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.39
|
| Rate for Payer: Priority Health SBD |
$106.03
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$50.97
|
| Rate for Payer: Aetna Medicare |
$29.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.98
|
| Rate for Payer: BCBS Complete |
$23.99
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Healthscope Commercial |
$53.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: PHP Commercial |
$50.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: Priority Health SBD |
$37.78
|
| Rate for Payer: UHC Core |
$44.38
|
| Rate for Payer: UHC Exchange |
$44.38
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$50.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.98
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Healthscope Commercial |
$53.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: PHP Commercial |
$50.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: Priority Health SBD |
$37.78
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.82
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Healthscope Commercial |
$49.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: Priority Health SBD |
$34.72
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.82
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Healthscope Commercial |
$49.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: Priority Health SBD |
$34.72
|
| Rate for Payer: UHC Core |
$40.78
|
| Rate for Payer: UHC Exchange |
$40.78
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$291.97 |
| Max. Negotiated Rate |
$417.11 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health SBD |
$291.97
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$342.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$342.95
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.44 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna Medicare |
$146.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.94
|
| Rate for Payer: BCBS Complete |
$79.21
|
| Rate for Payer: BCBS MAPPO |
$140.75
|
| Rate for Payer: BCN Medicare Advantage |
$140.75
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Cofinity Commercial |
$577.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.75
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Mclaren Medicaid |
$75.44
|
| Rate for Payer: Mclaren Medicare |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.79
|
| Rate for Payer: Meridian Medicaid |
$79.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: PACE Medicare |
$133.71
|
| Rate for Payer: PACE SWMI |
$140.75
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: PHP Medicare Advantage |
$140.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health Medicare |
$140.75
|
| Rate for Payer: Priority Health SBD |
$519.93
|
| Rate for Payer: Railroad Medicare Medicare |
$140.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.20
|
| Rate for Payer: UHC Core |
$610.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.75
|
| Rate for Payer: UHC Exchange |
$610.71
|
| Rate for Payer: UHC Medicare Advantage |
$140.75
|
| Rate for Payer: UHCCP Medicaid |
$79.24
|
| Rate for Payer: VA VA |
$140.75
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$519.93 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.43
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$577.70
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health SBD |
$519.93
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$114.36 |
| Max. Negotiated Rate |
$163.38 |
| Rate for Payer: Aetna Commercial |
$154.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.99
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$127.07
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Healthscope Commercial |
$163.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: PHP Commercial |
$154.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: Priority Health SBD |
$114.36
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$154.30
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$127.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$163.38
|
| 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 |
$154.30
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$154.30
|
| 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 |
$117.99
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$114.36
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$134.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$326.75 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$254.13
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health SBD |
$228.72
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Commercial |
$254.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$228.72
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$268.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$268.66
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$326.75 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$254.13
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health SBD |
$228.72
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Commercial |
$254.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$326.75
|
| 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 |
$308.59
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$308.59
|
| 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 |
$235.98
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$228.72
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$268.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$268.66
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$440.84
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$446.03
|
| Rate for Payer: Cofinity Commercial |
$363.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$466.78
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$440.84
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$326.74
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$383.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$383.79
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$326.74 |
| Max. Negotiated Rate |
$466.78 |
| Rate for Payer: Aetna Commercial |
$440.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.12
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$363.05
|
| Rate for Payer: Cofinity Commercial |
$446.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Healthscope Commercial |
$466.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: PHP Commercial |
$440.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health SBD |
$326.74
|
|
